Background: Sepsis is one of the leading causes of admission to intensive care units (ICU), and it is one of the most expensive conditions treated in United State Hospitals accounting for $20.3 billion or 5.2% of total hospitalization cost. Idiopathic pulmonary fibrosis (IPF) is one of the leading causes of interstitial lung disease, with currently no successful treatment for it, patients with acute decompensation usually end up requiring ICU level of care. We sought to investigate the effect of sepsis in patients with underlying diagnosis of IPF.
Methods: We queried the 2018 National Inpatient Sample (NIS) for adult patients with Sepsis as primary diagnosis with and without IPF as a secondary diagnosis. The primary outcome was inpatient mortality, while secondary outcomes were the length of stay (LOS), total hospital cost (THC), and the need for invasive mechanical ventilation (IMV). A multivariable logistic regression analysis was applied to estimate the clinical outcome. A p-value of < 0.05 was significant.
Results: A total of 2,194,360 patients with Sepsis were admitted, of which 1.56% had IPF. IPF vs No IPF cohorts included a mean age of 72 years[CI 71.7-72.4] vs 65 years [CI 64.8-65.1], males (49.7% vs 49.7%); white (70.8% vs 68.8%), black (9.6% vs 13.3%), and Hispanic (12.8% vs 11.3%). Hospitalization for Sepsis with IPF had a statistically significant increase in mortality (13.8% vs 8.9%, AOR 1.47, 95% CI 1.36 – 1.59, P< 0.0001), increase in need for IMV ( 11.8% vs 8.6% AOR 1.30, 95% CI 1.20 - 1.42, P< 0.0001) with an adjusted increase in mean hospital charge of $16,082 (95% CI 12578 - 19586, P< 0.0001) but no significant difference in the average length of stay compared to those without IPF.
Conclusions: We observed that patients with IPF admitted with sepsis had an increase in mortality, increase in need for invasive mechanical ventilation and increased burden to health care cost. An early prognosis discussion with IPF patients and families can help guide goals of care.