Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit. (19th December 2018)

• Record Type: Journal Article
• Authors: Huapaya, Julio A.; Wilfong, Erin M.; Harden, Christopher T.; Brower, Roy G.; Danoff, Sonye K.
• Is Part Of: European respiratory review. Volume 27:Number 150(2018)
• Publication Date: 2018-12-19
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases; Respiratory organs -- Diseases; Respiratory organs -- Diseases -- Treatment; Electronic journals; Periodical; Periodicals; Periodicals; 616.2
• DOI: 10.1183/16000617.0061-2018
• Languages: English
• ISSNs: 0905-9180

Abstract

Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU. We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%. Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high. Elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality in ILD. No increased mortality was found with steroid use. Evidence on advanced age is inconclusive. Survival may be improving over time, but still remains high. http://ow.ly/6F1d30mijdy