University of Oulu

Salonen J, Vähänikkilä H, Purokivi M, Kaarteenaho R (2020) Causes of acute respiratory hospitalizations predict survival in fibrosing interstitial lung diseases. PLoS ONE 15(11): e0242860.

Causes of acute respiratory hospitalizations predict survival in fibrosing interstitial lung diseases

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Author: Salonen, Johanna1,2; Vähänikkilä, Hannu3; Purokivi, Minna;
Organizations: 1Respiratory Medicine, Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
2Medical Research Center (MRC) Oulu, Oulu University Hospital, Oulu, Finland
3Infrastructure for Population Studies, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.4 MB)
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Language: English
Published: Public Library of Science, 2020
Publish Date: 2020-12-10


Acute exacerbation of ILD (AE-ILD) is a common reason for hospitalization; it is also associated with significant mortality. Less is known about the prognostic significance of other events causing acute, non-elective hospitalizations in ILD patients. ILD patients hospitalized due to acute respiratory worsening were collected from medical records. Reasons for respiratory deterioration were classified into AE-ILDs and other causes. Clinical features and survival data of idiopathic pulmonary fibrosis (IPF) and other types of ILDs were evaluated and compared. In all, 237 patients (138 with IPF and 99 with other ILD) fulfilled the inclusion criteria. Of the non-IPF ILD types, the most prevalent subgroups were connective tissue disease-associated ILD (n = 33) and asbestosis (n = 22). The most common cause for hospitalization was AE-ILD explaining 41% of hospitalizations. Lower respiratory tract infection (22%), subacute progression of ILD (12%) and cardiovascular causes (7.2%) were other common reasons for hospital treatment. Patients with a lower respiratory tract infection had a more favorable prognosis compared with patients with AE-ILD. AE-ILDs were less fatal than cardiovascular or concurrent non-ILD-related causes for hospitalizations in non-IPF patients. High Gender-Age-Physiology (GAP) index was a marker for shortened survival and earlier AE-ILDs in all patients. IPF patients had a significantly shorter overall and post-hospitalization survival time compared with other ILDs. Most respiratory hospitalizations in ILD patients were related to causes other than AE-ILD, which highlights the importance of accurate differential diagnosis in order to target the appropriate treatment for each ILD patient.

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Series: PLoS one
ISSN: 1932-6203
ISSN-E: 1932-6203
ISSN-L: 1932-6203
Volume: 15
Issue: 11
Article number: e0242860
DOI: 10.1371/journal.pone.0242860
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: JS has received personal grants for scientific work from Foundation of the Finnish Anti-Tuberculosis Association ( and the Research Foundation of the Pulmonary Diseases HES ( RK has received grants for the study group from Foundation of the Finnish Anti-Tuberculosis Association, the Research Foundation of the Pulmonary Diseases, Jalmari and Rauha Ahokas Foundation ( and the Research Foundation of North Finland (no url).
Dataset Reference: Supporting information
Copyright information: © 2020 Salonen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.