title: Outcomes after hospitalization in idiopathic pulmonary fibrosis: a cohort study.
abstract: OBJECTIVE
  The outcomes of patients with idiopathic pulmonary fibrosis (IPF) who undergo hospitalization have not been well characterized. We sought to determine the frequency of all-cause and respiratory-related hospitalizations and to evaluate their impact on the subsequent course and survival of patients with IPF.
  
  
  METHODS
  The records of patients with IPF evaluated at a tertiary center were examined for the cause and duration of hospitalization. Data on subsequent patient outcomes were collated.
  
  
  RESULTS
  The IPF cohort consisted of 592 patients, 25.3% of whom were hospitalized subsequent to their IPF diagnosis. A respiratory-related cause accounted for 77.3% of these hospitalizations. The median transplant-free survival for all patients was 23.3 months (interquartile range [IQR], 7.6-63.6 months) from the time of consultation. Transplant-free survival after hospital admission was much lower for patients with a respiratory hospitalization compared with those with a nonrespiratory hospitalization (median survival, 2.8 months [IQR, 0.63-16.2 months] vs 27.7 months [IQR, 7.4-59.6 months]; P = .0004). Multivariate analyses demonstrated that both all-cause and respiratory-related hospitalizations were strongly associated with mortality after adjusting for baseline demographics. Among patients with a respiratory hospitalization, 22.4% died while in the hospital, whereas 16.4% eventually went on to lung transplantation.
  
  
  CONCLUSIONS
  Hospitalizations are common events in patients with IPF. Most hospitalizations are respiratory-related and are associated with high in-hospital mortality and limited survival beyond discharge. Both all-cause and respiratory hospitalizations are associated with mortality, and therefore, either could be used as an end point in IPF clinical trials.
authors.affiliation: Advanced Lung Disease and Transplant Program; University of California at Los Angeles, Los Angeles, CA.
authors.forename: A Whitney
authors.initials: AW
authors.lastname: Brown
authors.affiliation: Advanced Lung Disease and Transplant Program; University of California at Los Angeles, Los Angeles, CA.
authors.forename: Chelsea P
authors.initials: CP
authors.lastname: Fischer
authors.affiliation: Advanced Lung Disease and Transplant Program; University of California at Los Angeles, Los Angeles, CA.
authors.forename: Oksana A
authors.initials: OA
authors.lastname: Shlobin
authors.affiliation: Department of Medicine, Inova Fairfax Hospital, Falls Church, VA; and the Department of Medicine; Department of Medicine; University of California at Los Angeles, Los Angeles, CA.
authors.forename: Russell G
authors.initials: RG
authors.lastname: Buhr
authors.affiliation: Advanced Lung Disease and Transplant Program; University of California at Los Angeles, Los Angeles, CA.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Advanced Lung Disease and Transplant Program; University of California at Los Angeles, Los Angeles, CA.
authors.forename: Nargues A
authors.initials: NA
authors.lastname: Weir
authors.affiliation: Advanced Lung Disease and Transplant Program; University of California at Los Angeles, Los Angeles, CA.. Electronic address: steven.nathan@inova.org.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Nathan
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate / Q000639:trends; D013997:Time Factors