Hospitalisation patterns in interstitial lung diseases: data from the EXCITING-ILD registry

Katharina Buschulte; Hans-Joachim Kabitz; Lars Hagmeyer; Peter Hammerl; Albert Esselmann; Conrad Wiederhold; Dirk Skowasch; Christoph Stolpe; Marcus Joest; Stefan Veitshans; Marc Höffgen; Phillen Maqhuzu; Larissa Schwarzkopf; Andreas Hellmann; Michael Pfeifer; Jürgen Behr; Rainer Karpavicius; Andreas Günther; Markus Polke; Philipp Höger; Vivien Somogyi; Christoph Lederer; Philipp Markart; Michael Kreuter

doi:10.1186/s12931-023-02588-y

Hospitalisation patterns in interstitial lung diseases: data from the EXCITING-ILD registry

Respir Res. 2024 Jan 4;25(1):5. doi: 10.1186/s12931-023-02588-y.

Authors

Katharina Buschulte¹, Hans-Joachim Kabitz², Lars Hagmeyer³, Peter Hammerl⁴, Albert Esselmann⁵, Conrad Wiederhold⁶, Dirk Skowasch⁷, Christoph Stolpe⁸, Marcus Joest⁹, Stefan Veitshans¹⁰, Marc Höffgen¹¹, Phillen Maqhuzu¹², Larissa Schwarzkopf^{12

13}, Andreas Hellmann¹⁴, Michael Pfeifer¹⁵, Jürgen Behr¹⁶, Rainer Karpavicius¹⁷, Andreas Günther¹⁸, Markus Polke¹⁹, Philipp Höger¹⁹, Vivien Somogyi²⁰, Christoph Lederer¹⁹, Philipp Markart^{18

21}, Michael Kreuter²²

Affiliations

¹ Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany. katharina.buschulte@med.uni-heidelberg.de.
² Medical Clinic II, Pneumology and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany.
³ Hospital Bethanien Solingen, Clinic of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Solingen, Germany.
⁴ Chest Clinic Immenhausen, Immenhausen, Germany.
⁵ Outpatient Center for Pulmonology, Warendorf, Germany.
⁶ Outpatient Center for Pulmonology, Fulda, Germany.
⁷ Department of Medicine II, University Hospital Bonn, Bonn, Germany.
⁸ Outpatient Center for Pulmonology, Ibbenbüren, Germany.
⁹ Outpatient Center for Pulmonology and Allergology, Bonn, Germany.
¹⁰ Outpatient Center for Pulmonology, Böblingen, Germany.
¹¹ Outpatient Center for Pulmonology, Rheine, Germany.
¹² Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPCM), Neuherberg, Germany.
¹³ IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany.
¹⁴ Outpatient Center for Pulmonology, Augsburg, Germany.
¹⁵ Medical Clinic II, University of Regensburg and Klinikum Donaustauf, Donaustauf, Germany.
¹⁶ Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Centre, German Center for Lung Research (DZL), Munich, Germany.
¹⁷ Patient Support Group Lungenfibrose e.V., Essen, Germany.
¹⁸ Medical Clinic II, University Hospital Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC), German Center for Lung Research (DZL), Giessen, Germany.
¹⁹ Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.
²⁰ Mainz Center for Pulmonary Medicine, Departments of Pneumology, ZfT, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany.
²¹ Medical Clinic V (Pneumology), Cardiothoracic Centre, Campus Fulda, University Medicine Marburg, Fulda, Germany.
²² Mainz Center for Pulmonary Medicine, Departments of Pneumology, ZfT, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany. Michael.Kreuter@marienhaus.de.

Abstract

Background: Interstitial lung diseases (ILD) comprise a heterogeneous group of mainly chronic lung diseases with more than 200 entities and relevant differences in disease course and prognosis. Little data is available on hospitalisation patterns in ILD.

Methods: The EXCITING-ILD (Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases) registry was analysed for hospitalisations. Reasons for hospitalisation were classified as all cause, ILD-related and respiratory hospitalisations, and patients were analysed for frequency of hospitalisations, time to first non-elective hospitalisation, mortality and progression-free survival. Additionally, the risk for hospitalisation according to GAP index and ILD subtype was calculated by Cox proportional-hazard models as well as influencing factors on prediction of hospitalisation by logistic regression with forward selection.

Results: In total, 601 patients were included. 1210 hospitalisations were recorded during the 6 months prior to registry inclusion until the last study visit. 800 (66.1%) were ILD-related, 59.3% of admissions were registered in the first year after inclusion. Mortality was associated with all cause, ILD-related and respiratory-related hospitalisation. Risk factors for hospitalisation were advanced disease (GAP Index stages II and III) and CTD (connective tissue disease)-ILDs. All cause hospitalisations were associated with pulmonary hypertension (OR 2.53, p = 0.005). ILD-related hospitalisations were associated with unclassifiable ILD and concomitant emphysema (OR = 2.133, p = 0.001) as well as with other granulomatous ILDs and a positive smoking status (OR = 3.082, p = 0.005).

Conclusion: Our results represent a crucial contribution in understanding predisposing factors for hospitalisation in ILD and its major impact on mortality. Further studies to characterize the most vulnerable patient group as well as approaches to prevent hospitalisations are warranted.

Keywords: Hospitalisation; ILD; IPF; Prognosis; Risk factors.

MeSH terms

Connective Tissue Diseases* / complications
Disease Progression
Hospitalization
Humans
Idiopathic Pulmonary Fibrosis*
Lung Diseases, Interstitial* / diagnosis
Lung Diseases, Interstitial* / epidemiology
Lung Diseases, Interstitial* / therapy
Registries