RESUMEN
Rationale: Little is known about hospitalization in other types of interstitial lung disease (ILD) besides idiopathic pulmonary fibrosis (IPF). Objectives: To determine the frequency of hospitalizations in various types of ILD and elucidate the association of hospitalization with outcomes. Methods: An analysis of the Pulmonary Fibrosis Foundation Patient Registry data was performed. Inpatient hospitalization rates and survival posthospitalization were compared for various types of ILD. Measurements and Main Results: Hospitalization rates were similar across ILD types: 40.6% of participants with IPF, 42.8% of participants with connective tissue disease-related ILD (CTD-ILD), 44.9% of participants with non-IPF idiopathic interstitial pneumonia (IIP), 46.5% of participants with chronic hypersensitivity pneumonitis (CHP), and 53.3% of participants with "other" ILD. All-cause hospitalization was not associated with decreased transplant-free survival (adjusted hazard ratio [AHR], 1.20; 95% confidence interval [CI] = 0.98, 1.46; P = 0.0759) after adjusting for comorbidities and severity of illness; however, respiratory-related hospitalization was (AHR, 1.53; 95% CI = 1.23, 1.90; P = 0.0001). Participants with CTD-ILD (HR, 0.43; 95% CI = 0.25, 0.75; P = 0.0031) and non-IPF IIP (HR, 0.3; 95% CI = 0.15, 0.58; P = 0.005) had a lower risk of death posthospitalization compared with those with IPF, whereas those with chronic hypersensitivity pneumonitis (HR, 0.67; 95% CI = 0.37, 1.20; P = 0.1747) or other ILD (HR, 0.54; 95% CI = 0.19, 1.54; P = 0.25) had a risk comparable with that for IPF. Conclusions: Rates of hospitalization are similar across ILD subtypes. The risk of death or transplant after posthospitalization is lower in patients with CTD-ILD and non-IPF IIP, compared with patients with IPF. In a mixed population of participants with ILD, all-cause hospitalizations were not associated with decreased transplant-free survival; however respiratory-related hospitalizations were.
Asunto(s)
Hospitalización , Enfermedades Pulmonares Intersticiales , Sistema de Registros , Humanos , Masculino , Femenino , Hospitalización/estadística & datos numéricos , Enfermedades Pulmonares Intersticiales/mortalidad , Enfermedades Pulmonares Intersticiales/epidemiología , Enfermedades Pulmonares Intersticiales/complicaciones , Persona de Mediana Edad , Anciano , Fibrosis Pulmonar Idiopática/mortalidad , Fibrosis Pulmonar Idiopática/epidemiología , Fibrosis Pulmonar Idiopática/complicaciones , Alveolitis Alérgica Extrínseca/epidemiología , Alveolitis Alérgica Extrínseca/mortalidad , Alveolitis Alérgica Extrínseca/complicacionesRESUMEN
The presence of a symptomatic and recurrent unilateral pleural effusion should alert physicians to consider thoracentesis with mindful use of biomarkers not only for therapeutic purposes, but also for diagnosis of both benign and malignant etiologies.
RESUMEN
An 86-year-old man was found with altered mental status, fever and aphasia. His physical exam revealed nuchal rigidity but no other meningeal signs. Because the patient's mental status was declining, he was intubated and placed in mechanical ventilation. His head CT scan was unremarkable, without evidence of mass effect. A lumbar puncture yielded cerebrospinal fluid that was remarkable for the presence of gram-positive cocci in pairs. His blood cultures showed gram-negative bacilli. Given the presence of these organisms, a polymicrobial infection was suspected. An abdomino pelvic CT scan showed a multi-septated abscess within the right hepatic lobe. CT-guided percutaneous drainage was performed and a specimen for culture obtained, which grew Klebsiella pneumoniae. After receiving intravenous antibiotics and supportive care, the patient showed clinical improvement. In this patient, there was a central nervous system infection secondary to bacteremia in the setting of an intrabdominal infection. The inquiring clinician should take note that whenever a polymicrobial infection is evidenced, more than one site of infection should be considered in the differential diagnosis.
Asunto(s)
Coinfección/complicaciones , Meningitis Bacterianas/complicaciones , Sepsis/microbiología , Anciano de 80 o más Años , Coinfección/diagnóstico , Coinfección/tratamiento farmacológico , Humanos , Masculino , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/tratamiento farmacológico , Sepsis/diagnóstico , Sepsis/tratamiento farmacológicoAsunto(s)
Enfermedades Bronquiales/etiología , Enfermedades Bronquiales/terapia , Cuerpos Extraños/complicaciones , Cuerpos Extraños/cirugía , Traqueostomía/métodos , Anciano , Antibacterianos , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/etiología , Infecciones Bacterianas/terapia , Bronquios/diagnóstico por imagen , Enfermedades Bronquiales/diagnóstico por imagen , Broncoscopía , Enfermedad Crónica , Desbridamiento , Cuerpos Extraños/diagnóstico por imagen , Humanos , Masculino , Respiración Artificial , Instrumentos Quirúrgicos , Tomografía Computarizada por Rayos X , Tráquea/cirugíaRESUMEN
Consider flexible bronchoscopy as an option to retrieve aspirated foreign bodies in the airway.