Prognostic effects of clinical and CT imaging features on critically ill patients with interstitial lung disease hospitalized in respiratory intensive care unit

Shenyun Shi,Yuying Qiu,Xiaohua Qiu,Yonglong Xiao,Hourong Cai,Yan Li,Kefeng Zhou

doi:10.1038/s41598-019-53865-0

Shenyun Shi, Yuying Qiu + Show 5 more

Open Access

https://doi.org/10.1038/s41598-019-53865-0

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Abstract

The study aimed to evaluate the clinical and imaging features of critically ill patients with interstitial lung disease (ILD) treated in respiratory intensive care unit (RICU) and assess the prognostic effects of these factors. A total of 160 severe ILD patients admitted to the RICU were finally enrolled in this study. The clinical, imaging and follow-up data of them were studied retrospectively. The in-hospital mortality and total mortality were 43.1% and 63.8% respectively. By multivariate cox regression analysis, shock (OR = 2.39, P = 0.004), pulmonary fibrosis on CT (OR = 2.85, P = 0.002) and non-invasive ventilation (OR = 1.86, P = 0.037) were harmful factors to survivals of critically ill patients with ILD. In contrast, oxygenation index (OR = 0.99, P = 0.028), conventional oxygen therapy (OR = 0.59, P = 0.048) and β-lactam antibiotics use (OR = 0.51, P = 0.004) were protective factors. There is significant difference of survivals between patients with and without fibrosing ILD on CT (Log-rank, p = 0.001). The prognosis of critically ill patients with ILD was poor. Shock, respiratory failure and fibrosing signs on chest CT affected the prognosis. Chest CT was considered as a valuable tool to indicate the prognosis.

Highlights

Interstitial lung disease (ILD) is a group of heterogeneous lung diseases with pulmonary alveolar unit inflammation or interstitial fibrosis
The diagnosis of ILD was mainly based on clinical, imaging and pathological data, and the specific diagnostic criteria referring to the guidelines of interstitial lung disease published by British thoracic society in 20083 and the 2013 American Thoracic Society/European Respiratory Society consensus classification update of the idiopathic interstitial pneumonias[4]
The death rate in the respiratory intensive care unit (RICU) was 43.1%, and respectively the total death rate was 63.8% according to the final follow-up

Summary

Introduction

Interstitial lung disease (ILD) is a group of heterogeneous lung diseases with pulmonary alveolar unit inflammation or interstitial fibrosis. ILD could be with specific etiology (connective tissue disease, environmental exposure, drugs, etc) or idiopathic[1]. Severe ILD can be life-threating and cause high mortality even though hospitalized in intensive care unit (ICU). There had been few studies on the clinical characteristics and survival analysis of critically ill ILD patients. One study reported a hospital mortality rate about 66% in patients with ILD requiring critical treatment in ICU2. To better understand the prognostic factors that can be evaluated in severe ILD patients, the clinical and imaging features of patients with severe ILD hospitalized in respiratory intensive care unit (RICU) were retrospectively reviewed

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