B79-09 Impact of Acute Respiratory Failure on Hospital Outcomes in Interstitial Lung Disease: Insights From the National Inpatient Sample

Abstract Introduction Interstitial lung disease (ILD) includes a wide range of chronic lung conditions that often progress to pulmonary fibrosis, especially in advanced stages. When patients with ILD experience acute respiratory failure (ARF), the clinical outcomes are frequently severe with a significant increase in morbidity and mortality. In-hospital mortality can reach 70 percent, and more than half of patients may die within a year. Several factors have been linked to poor outcomes in ILD patients who develop ARF, including high ventilatory support needs, vasopressor use, high-dose steroids, and complications such as pulmonary hypertension or acute kidney injury. This study aims to assess the impact of ARFon in-hospital outcomes among ILD patients using a large, nationally representative dataset. Methods A retrospective cross-sectional analysis was conducted using the National Inpatient Sample (NIS) from 2018 to 2021. ILD and ARF were identified using ICD-10 codes J84. x and J96. x. Patients under18 years, elective admissions, and those with chronic respiratory failure or missing mortality data were excluded. The primary exposure was ARF during hospitalization among ILD admissions. The primary outcome was in-hospital mortality, with secondary outcomes including mechanical ventilation, length of stay (LOS), palliative care involvement, and total charges. Survey-weighted logistic regression models adjusted for age, sex, race, and comorbidities were performed using DISCWT (weights), NISSTRATUM (strata), and HOSPNIS (clusters). Analyses were conducted with IBM SPSS Statistics version 29. 0. Results Of 143, 235, 038 weighted discharges, 1, 232, 513 (0. 9%) involved ILD patients with ARF. The mean age was 67. 6 years, and the mean LOS was 6. 9 days. In-hospital mortality was significantly higher among ILD patients with ARF (adjusted odds ratio AOR1. 90, 95% CI 1. 75-2. 07). ARF was associated with greater mechanical ventilation use (AOR 1. 50 for 24-96 hours) and palliative care involvement (AOR 1. 38). Lower mortality odds were observed with female sex (AOR 0. 96), older age (AOR 0. 98), and longer LOS (AOR 0. 99). Conclusion Hospitalized ILD patients who developed ARF had significantly worse clinical outcomes, with higher mortality and greater ventilatory support needs. These findings emphasize the substantial clinical burden of ARF in ILD and highlight the importance of early recognition and targeted supportive care strategies to improve outcomes. This abstract is funded by: None