B41-25 Clinical Characteristics and Treatment Patterns of Patients With ILD Hospitalized for Respiratory Decompensation

Abstract Rationale Acute exacerbations of interstitial lung disease (AE-ILD) are a major complication of ILD. AEs are associated with high mortality with median survival of 3-4 months post-event. Despite the seriousness of these events, there are no clear guidelines for management and clinical practices vary. Here, we describe clinical characteristics and treatment patterns of a prospective cohort of patients with ILD hospitalized with acute respiratory decompensation. Methods We conducted a prospective observational cohort study enrolling adults with ILD admitted to Duke University Hospital with acute respiratory decompensation between August 2023 and June 2025. Patients with pulmonary embolism or pneumothorax were excluded. Clinical data, treatment patterns, and clinical outcomes, particularly 90-day death or lung transplant, were extracted from the electronic medical record and summarized using descriptive statistics. AE was defined as worsening oxygen requirement with new pulmonary infiltrates or clinical diagnosis per the opinion of the treating pulmonologist. Fisher’s exact test was used to compare the proportion of patients with vs without clinical diagnosis of AE who experienced death or lung transplant within 90 days. Results Among the enrolled cohort (n = 88), 47 (53.4%) were male. The median age at admission was 66.5 (58.4,73.1) years. The median body mass index (BMI) was 28.5 (24.2, 32.6). Demographics and clinical characteristics of the cohort are summarized in Table 1. Among the cohort, 53 patients (60.2%) met clinical criteria for AE. Treatment during hospitalization included corticosteroid therapy for 79 patients (89.8%), with 42 patients receiving more than 125 mg of methylprednisolone daily. Twenty-seven (77.1%) of the 35 patients without clinical AE received steroids. Microbiologic testing identified an infectious cause in 18 patients (20.5%), while 51 (58%) received at least one antibiotic during their hospital stay. At 90 days following hospitalization, 36 patients (40.9%) had either died or underwent a lung transplant. 90-day mortality or transplant was higher for those with AE compared to those without, 29 (54.7%) vs. 7 (20%), respectively (p = 0.003). Conclusion Our data suggests that steroids are frequently used to treat patients with ILD hospitalized with respiratory decompensation, regardless of whether they meet clinical criteria for AE. The risk of 90-day mortality or need for transplant is substantial in this cohort, with significantly higher rates observed among patients with AE compared to those without. These findings highlight the need for new treatments to improve outcomes in this high-risk population. This abstract is funded by: None