@article {9245, title = {Late mortality after acute hypoxic respiratory failure.}, journal = {Thorax}, year = {2017}, 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.

}, keywords = {Health Shocks, Mortality, Respiratory Disease}, issn = {1468-3296}, doi = {10.1136/thoraxjnl-2017-210109}, author = {Hallie C Prescott and Sjoding, Michael W and Kenneth M. Langa and Theodore J Iwashyna and Daniel F McAuley} }