In sarcoidosis, respiratory failure hospitalizations rising, inpatient mortality falling

From 2007 to 2018, hospitalizations for respiratory failure increased, while respiratory failure-related mortality declined among individuals with sarcoidosis, according to data published in Chest.

Researchers analyzed data on 236,315 hospitalizations of patients with pulmonary sarcoidosis (mean age, 58 years; 61% women) from 2007 to 2018 in the National Inpatient Sample. Twenty-one percent of patients hospitalized had respiratory failure and 19% had pneumonia.

Hospitalizations among patients with pulmonary sarcoidosis increased from 258.5 per 1 million hospitalizations in 2007 to 705.7 per 1 million hospitalizations in 2018.

Hospitalizations for respiratory failure increased from 25.9 per 1 million hospitalizations in 2007 to 239.4 per 1 million hospitalizations in 2018. Hospitalizations that required mechanical ventilation also increased from 9.4 per 1 million hospitalizations in 2007 to 29.4 per 1 million hospitalizations in 2018.

Mortality was 13 times higher among patients with respiratory failure (10.6% vs. 0.8%) and 26 times higher among patients who required mechanical ventilation (31.2% vs. 1.2%) compared with patients who did not. The rate of all-cause inpatient mortality overall from 2007 to 2018 was 2.6%.

The rate of inpatient mortality associated with respiratory failure declined 50% during the study period, from 17.2% in 2007 to 6.6% in 2018.

Older age (adjusted HR = 1.025; 95% CI, 1.022-1.027), respiratory failure (aHR = 3.12; 95% CI, 2.89-3.36), need for mechanical ventilation (aHR = 6.01; 95% CI, 5.62-6.42), pulmonary hypertension (aHR = 1.44; 95% CI, 1.36-1.53), acute pulmonary embolism (aHR = 1.61; 95% CI, 1.44-1.8) and frailty (aHR = 3.1; 95% CI, 1.86-5.17) were independent predictors of inpatient mortality, according to the researchers.

“In addition to respiratory failure and need for mechanical ventilation, older age, pulmonary hypertension, PE, low BMI, frailty and use of supplemental oxygen were independent risk factors for increased mortality in patients with pulmonary sarcoidosis who were hospitalized,” Shehabaldin Alqalyoobi, MD, internal medicine specialist in the division of pulmonary, critical care and sleep medicine at the Brody School of Medicine at East Carolina University in Greenville, North Carolina, and with the department of bioinformatics and biostatistics at the University of Louisville School of Public Health and Information Sciences, Kentucky, and colleagues wrote. “Further studies are needed to explain the factors driving these findings.”