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Low hospital mortality in patients with acute interstitial pneumonia
Amir Quefatieh1, Chad H Stone, Bruno DiGiovine
1Division of Pulmonary, Critical Care, Allergy, Immunology and Sleep Medicine, Henry Ford Health Sciences Center, Detroit, USA.
Study Objectives:
To compare the presenting features and outcome of patients with acute interstitial pneumonia (AIP) with other patients with diffuse alveolar damage (DAD) and with historical control subjects.
Design:
Retrospective chart review.
Setting:
A large, urban, teaching hospital.
Interventions:
Patients were classified into idiopathic (AIP group) and secondary causes of DAD (ARDS group) according to available clinical and microbiology data. AIP and ARDS cases were compared, and ARDS cases were analyzed for long-term outcome.
Measurements And Results:
Twenty patients with pathologic diagnosis of DAD were identified. Four cases were excluded; eight cases of ARDS due to known etiologies were identified. These etiologies included pneumonia and sepsis (n = 6), cocaine use (n = 1), and carmustine chemotherapy (n = 1). Eight cases of AIP were found. When compared with the ARDS group, patients in the AIP group had a longer time from the onset of symptoms until hospital admission (16.8 +/- 15.7 days vs 2.2 +/- 1.0 days, p = 0.0015) and a shorter time from hospital admission to open-lung biopsy (8.3 +/- 3.0 days vs 15.5 +/- 9.5 days, p = 0.02) [mean +/- SD]. Seven of eight patients with AIP and four of eight patients with ARDS survived to hospital discharge (p = not significant). The 12.5% mortality rate for patients with AIP reported in this series was significantly lower than the previously reported cumulative rate of 69.5% (p = 0.0025). Follow-up in five AIP survivors for a mean of 7.6 +/- 3.5 years (range, 3 to 11 years) showed all to be without shortness of breath or relapse despite mild residual fibrosis on chest radiograph and mild-to-moderate restriction on pulmonary function tests (mean total lung capacity, 68.5 +/- 6.2% predicted).
Conclusions:
Our data support a favorable hospital and long-term outcome for patients with AIP, with no evidence of recurrence or progression to chronic interstitial lung disease.
Insights
Patients with acute interstitial pneumonia (AIP) show a better prognosis than those with acute respiratory distress syndrome (ARDS). This study found a lower mortality rate and favorable long-term outcomes for AIP patients.
Area of Science:
- Pulmonology
- Critical Care Medicine
- Pathology
Background:
- Diffuse alveolar damage (DAD) is a severe lung injury with high mortality.
- Distinguishing idiopathic pulmonary fibrosis (IPF) from secondary causes of DAD is crucial for prognosis and management.
- Previous studies have reported high mortality rates for DAD, but outcomes for specific subtypes like AIP require further investigation.
Purpose of the Study:
- To compare the clinical presentation and outcomes of patients with acute interstitial pneumonia (AIP) against other causes of diffuse alveolar damage (DAD).
- To evaluate the long-term prognosis for patients diagnosed with AIP.
- To assess the mortality rate of AIP in comparison to historical data and other DAD etiologies.
Main Methods:
- Retrospective chart review of patients diagnosed with DAD at a large urban teaching hospital.
- Patients were categorized into the AIP group (idiopathic) and the ARDS group (secondary causes of DAD) based on clinical and microbiological data.
- Comparison of presenting features, time to diagnosis, and survival rates between AIP and ARDS groups; long-term follow-up of AIP survivors.
Main Results:
- Eight cases of AIP and eight cases of ARDS were identified and analyzed.
- AIP patients presented with a significantly longer delay from symptom onset to hospital admission (16.8 days vs. 2.2 days) but underwent lung biopsy sooner after admission (8.3 days vs. 15.5 days) compared to ARDS patients.
- Hospital survival rates were similar (7/8 for AIP vs. 4/8 for ARDS), but the mortality rate for AIP in this series (12.5%) was significantly lower than historical rates (69.5%).
Conclusions:
- Patients with acute interstitial pneumonia (AIP) experience favorable hospital and long-term outcomes.
- No evidence of disease recurrence or progression to chronic interstitial lung disease was observed in AIP survivors.
- The findings suggest that AIP may have a better prognosis than previously reported, warranting further investigation into its specific management and outcomes.