Title | Late mortality after acute hypoxic respiratory failure. |
Publication Type | Journal Article |
Year of Publication | 2017 |
Authors | Prescott, HC, Sjoding, MW, Langa, KM, Iwashyna, TJ, McAuley, DF |
Journal | Thorax |
ISSN Number | 1468-3296 |
Keywords | Health Shocks, Mortality, Respiratory Disease |
Abstract | BACKGROUND: Acute hypoxic respiratory failure (AHRF) is associated with significant acute mortality. It is unclear whether later mortality is predominantly driven by pre-existing comorbid disease, the acute inciting event or is the result of AHRF itself. METHODS: Observational cohort study of elderly US Health and Retirement Study (HRS) participants in fee-for-service Medicare (1998-2012). Patients hospitalised with AHRF were matched 1:1 to otherwise similar adults who were not currently hospitalised and separately to patients hospitalised with acute inciting events (pneumonia, non-pulmonary infection, aspiration, trauma, pancreatitis) that may result in AHRF, here termed at-risk hospitalisations. The primary outcome was late mortality-death in the 31 days to 2 years following hospital admission. RESULTS: Among 15 075 HRS participants, we identified 1268 AHRF and 13 117 at-risk hospitalisations. AHRF hospitalisations were matched to 1157 non-hospitalised adults and 1017 at-risk hospitalisations. Among patients who survived at least 30 days, AHRF was associated with a 24.4% (95%CI 19.9% to 28.9%, p<0.001) absolute increase in late mortality relative to adults not currently hospitalised and a 6.7% (95%CI 1.7% to 11.7%, p=0.01) increase relative to adults hospitalised with acute inciting event(s) alone. At-risk hospitalisation explained 71.2% of the increased odds of late mortality, whereas the development of AHRF itself explained 28.8%. Risk for death was equivalent to at-risk hospitalisation beyond 90 days, but remained elevated for more than 1 year compared with non-hospitalised controls. CONCLUSIONS: In this national sample of older Americans, approximately one in four survivors with AHRF had a late death not explained by pre-AHRF health status. More than 70% of this increased risk was associated with hospitalisation for acute inciting events, while 30% was associated with hypoxemic respiratory failure. |
DOI | 10.1136/thoraxjnl-2017-210109 |
User Guide Notes | |
Alternate Journal | Thorax |
Citation Key | 9245 |
PubMed ID | 28780503 |
PubMed Central ID | PMC5799038 |
Grant List | K01 HL136687 / HL / NHLBI NIH HHS / United States K08 GM115859 / GM / NIGMS NIH HHS / United States T32 HL007749 / HL / NHLBI NIH HHS / United States U01 AG009740 / AG / NIA NIH HHS / United States |