Impact of Comorbid Interstitial Lung Abnormalities on Acute Exacerbations of COPD: A Hospital-Based Retrospective...

To assess the influence of comorbid interstitial lung abnormalities (ILA), lung fibrosis (LF), and interstitial lung disease (ILD) on clinical characteristics and in-hospital outcomes in acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

In this retrospective cohort study, AECOPD patients were stratified by ILA, LF, or ILD status. Multivariable regression analyzed associations with outcomes, including in-hospital mortality, ICU admission, ventilation use, 30-day readmission, and length of stay (LOS). Subgroup and sensitivity analyses assessed robustness.

Among 11,457 AECOPD patients, 33.1% had ILA, 25.9% had LF, and 5.0% had ILD. After multivariable adjustment for potential confounders, the presence of ILA, LF, or ILD was not independently associated with in-hospital mortality (ILA: aOR 0.93, 95% CI 0.75-1.14; LF: aOR 0.87, 95% CI 0.70-1.10; ILD: aOR 1.04, 95% CI 0.70-1.53). All conditions significantly increased ICU admission and noninvasive ventilation use but reduced invasive ventilation use.

While not independent mortality predictors, ILA/LF/ILD signify greater disease severity and resource utilization during AECOPD, evidenced by higher ICU needs yet paradoxically lower invasive ventilation, a pattern that might be attributed to distinct pathophysiology and clinical management goals in this complex subgroup. This underscores clinical heterogeneity and necessitates tailored management and goals-of-care discussions for this high-risk subgroup.