Outcome of patients with interstitial lung disease admitted to the intensive care unit

The outcome of acute respiratory failure (ARF) affecting patients with various interstitial lung diseases (ILD) is poorly defined particularly in those with drug-induced ILD (DI-ILD). We investigated this issue focusing on fibrosing idiopathic interstitial pneumonitis (FIIP) and DI-ILD.

We carried out a retrospective study of patients with ILD admitted in a single center ICU. The primary end-point was in-hospital mortality.

We included 72 subjects who fell into 3 diagnostic groups: DI-ILD (n=20), FIIP (n=28) and miscellaneous (M-ILD) (n=24). In-hospital mortality rates were 40% (n=8/20), 68% (n=19/28), and 25% (n=6/24) for DI-ILD, FIIP and M-ILD, respectively, (p=0.006). It reached, 64% (n=7/11), 100% (n=17/17) and 60% (n=6/10), respectively, in subjects on mechanical ventilation (p=0.007). In multivariate analysis, the need for mechanical ventilation (OR= 35; [95% CI, 5-255]), the type of ILD (FIIP vs miscellaneous) (OR=22; [95% CI, 3-147]) and high-dose steroids during ICU stay (OR=0.19; [95% CI, 0.04-0.99]) were independent determinants of in-hospital mortality.

This study, while confirming the poor prognosis of FIIP patients in ICU, highlights the better prognosis of DI-ILD and M-ILD even though severity criteria on admission are similar in these 3 groups. These data impact on the management of these patients in ICU in whom a proper diagnostic of the underlying condition is crucial.