Late mortality after acute hypoxic respiratory failure. Issue 7 (5th August 2017)

• Record Type: Journal Article
• Authors: Prescott, Hallie C; Sjoding, Michael W; Langa, Kenneth M; Iwashyna, Theodore J; McAuley, Daniel F
• Is Part Of: Thorax. Volume 73:Issue 7(2018)
• Page Start: 618
• Page End: 625
• Publication Date: 2017-08-05
• Subjects: Ards -- Assisted Ventilation -- Clinical Epidemiology -- Respiratory Infection; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2017-210109
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Acute hypoxic respiratory failure (AHRF) is associated with significant acute mortality. It is unclear whether later mortality is predominantly driven by pre-existing comorbid disease, the acute inciting event or is the result of AHRF itself. Methods: Observational cohort study of elderly US Health and Retirement Study (HRS) participants in fee-for-service Medicare (1998–2012). Patients hospitalised with AHRF were matched 1:1 to otherwise similar adults who were not currently hospitalised and separately to patients hospitalised with acute inciting events (pneumonia, non-pulmonary infection, aspiration, trauma, pancreatitis) that may result in AHRF, here termed at-risk hospitalisations. The primary outcome was late mortality—death in the 31 days to 2 years following hospital admission. Results: Among 15 075 HRS participants, we identified 1268 AHRF and 13 117 at-risk hospitalisations. AHRF hospitalisations were matched to 1157 non-hospitalised adults and 1017 at-risk hospitalisations. Among patients who survived at least 30 days, AHRF was associated with a 24.4% (95%CI 19.9% to 28.9%, p<0.001) absolute increase in late mortality relative to adults not currently hospitalised and a 6.7% (95%CI 1.7% to 11.7%, p=0.01) increase relative to adults hospitalised with acute inciting event(s) alone. At-risk hospitalisation explained 71.2% of the increased odds of late mortality, whereas the development of AHRF itself explained 28.8%. Risk for death was equivalent to at-risk hospitalisation beyond 90 days, but remained elevated for more than 1 year compared with non-hospitalised controls. Conclusions: In this national sample of older Americans, approximately one in four survivors with AHRF had a late death not explained by pre-AHRF health status. More than 70% of this increased risk was associated with hospitalisation for acute inciting events, while 30% was associated with hypoxemic respiratory failure.