{
  "abstract": "Background Interstitial lung diseases (ILDs) are a heterogeneous group of often progressive, unpredictable diseases. They frequently result in hospitalisations secondary to respiratory decompensation, termed ILD-related admissions. A proportion are due to an acute exacerbation of ILD (AEILD). All are associated with high mortality but are poorly characterised in real-world populations.Aim To evaluate mortality outcomes and associated risk factors following ILD-related hospital admissions, including AEILD.Methods We conducted a multicentre retrospective cohort study of primary International Classification of Diseases Version 10 coded admissions for ILD between 1 January 2017 and 31 December 2019 across 11 NHS hospitals in the North West of England. AEILD events were classified using clinical criteria: <30-day respiratory deterioration not secondary to cardiac failure, pulmonary embolism or pneumothorax. The AEILD subgroup was divided into those with CT confirmation (definite AEILD) and without CT confirmation (suspected AEILD). Primary outcome was time from admission to death. Statistical analyses included Kaplan-Meier and multivariate proportional hazards modelling.Results Of 938 ILD-related admissions, 54.5% met study AEILD criteria. Overall, cumulative all-cause mortality to 90-days post-discharge was 40.2%. For the AEILD cohort, cumulative all-cause mortality to 90-days post-discharge was 47.6%. Median survival of the AEILD cohort was 107 days (95% CI 87.0 to 141.0 days) and the other ILD-related admission cohort 241.0 days (95% CI 208.0 to 308.0 days), with a statistically significant difference in survival (p<0.0001). 37.6% (192/511) of AEILD events had CT confirmation. Within the AEILD subgroup, median survival was higher in the CT group (144 days vs 100 days, p=0.027). AEILD was independently associated with mortality in a multivariate model. Preadmission oxygen, age and neutrophilia were associated with mortality in both ILD-admission and AEILD 90-day all-cause mortality models. 13.9% of admissions had documented palliative care input.Conclusions Mortality associated with ILD-related admissions is high, with AEILD events independently associated with mortality. Findings highlight the need for improved education, access to palliative care and targeted AEILD research.",
  "authors": [
    {
      "affiliations": [
        "Lancaster Medical School, Lancaster University, Lancaster, UK",
        "Respiratory Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK"
      ],
      "name": "Laura Jane White"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Stockport NHS Foundation Trust, Stockport, UK"
      ],
      "name": "Jonathon Shaw"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK"
      ],
      "name": "Bethan Powell"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK"
      ],
      "name": "Nyan M Kyi"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK"
      ],
      "name": "Alicia Sou"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Bolton NHS Foundation Trust, Bolton, UK",
        "Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester, UK"
      ],
      "name": "Gareth Edward Hughes"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Bolton NHS Foundation Trust, Bolton, UK"
      ],
      "name": "Dilanka Tilakaratne"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK",
        "School of Medical Sciences, The University of Manchester, Manchester, UK"
      ],
      "name": "Conal Hayton"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK"
      ],
      "name": "Trishala Raj"
    },
    {
      "affiliations": [
        "Manchester Royal Infirmary, Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Vi Truong"
    },
    {
      "affiliations": [
        "Manchester Royal Infirmary, Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Nashwah Ismail"
    },
    {
      "affiliations": [
        "Manchester Royal Infirmary, Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Nawat Khanijoun"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"
      ],
      "name": "Rebecca Huang"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"
      ],
      "name": "Emma Hardy"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"
      ],
      "name": "Zainab Aslam"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"
      ],
      "name": "Mahum Sohail"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"
      ],
      "name": "Mahzaib Babar"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"
      ],
      "name": "Amsal Amjad"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"
      ],
      "name": "Naayaab Khan"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"
      ],
      "name": "Martin Regan"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"
      ],
      "name": "Oby Okpala"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"
      ],
      "name": "Ragavilasini Suresh"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"
      ],
      "name": "Jerome Mcintosh"
    },
    {
      "affiliations": [
        "Lancaster Medical School, Lancaster University, Lancaster, UK"
      ],
      "name": "Amy Gadoud"
    },
    {
      "affiliations": [
        "Respiratory Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK",
        "The Pears Cumbria School of Medicine, Imperial College London, Carlisle, UK"
      ],
      "name": "Timothy Gatheral"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK"
      ],
      "name": "Georges Ng Man Kwong"
    }
  ],
  "title": "Mortality and diagnostic practice variation in interstitial lung disease admissions: insights from a multicentre UK cohort study",
  "uid": "51e9cd1b-5c5a-5486-8975-09bf8b1aeef0"
}