{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:42:23Z","timestamp":1792629743563,"version":"4.5.0"},"reference-count":39,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["Contract Only - Academic Clinical Fellowship"],"award-info":[{"award-number":["Contract Only - Academic Clinical Fellowship"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,3,4]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Interstitial lung diseases (ILDs) are a heterogeneous group of often progressive, unpredictable diseases. They frequently result in hospitalisations secondary to respiratory decompensation, termed ILD-related admissions. A proportion are due to an acute exacerbation of ILD (AEILD). All are associated with high mortality but are poorly characterised in real-world populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate mortality outcomes and associated risk factors following ILD-related hospital admissions, including AEILD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicentre retrospective cohort study of primary International Classification of Diseases Version 10 coded admissions for ILD between 1 January 2017 and 31 December 2019 across 11 NHS hospitals in the North West of England. AEILD events were classified using clinical criteria: &lt;30-day respiratory deterioration not secondary to cardiac failure, pulmonary embolism or pneumothorax. The AEILD subgroup was divided into those with CT confirmation (definite AEILD) and without CT confirmation (suspected AEILD). Primary outcome was time from admission to death. Statistical analyses included Kaplan-Meier and multivariate proportional hazards modelling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 938 ILD-related admissions, 54.5% met study AEILD criteria. Overall, cumulative all-cause mortality to 90-days post-discharge was 40.2%. For the AEILD cohort, cumulative all-cause mortality to 90-days post-discharge was 47.6%. Median survival of the AEILD cohort was 107 days (95%\u2009CI 87.0 to 141.0\u2009days) and the other ILD-related admission cohort 241.0\u2009days (95%\u2009CI 208.0 to 308.0\u2009days), with a statistically significant difference in survival (p&lt;0.0001). 37.6% (192\/511) of AEILD events had CT confirmation. Within the AEILD subgroup, median survival was higher in the CT group (144 days vs 100 days, p=0.027). AEILD was independently associated with mortality in a multivariate model. Preadmission oxygen, age and neutrophilia were associated with mortality in both ILD-admission and AEILD 90-day all-cause mortality models. 13.9% of admissions had documented palliative care input.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mortality associated with ILD-related admissions is high, with AEILD events independently associated with mortality. Findings highlight the need for improved education, access to palliative care and targeted AEILD research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-004017","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T15:25:21Z","timestamp":1775229921000},"page":"e004017","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Mortality and diagnostic practice variation in interstitial lung disease admissions: insights from a multicentre UK cohort study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1991-3897","authenticated-orcid":false,"given":"Laura Jane","family":"White","sequence":"first","affiliation":[{"name":"Lancaster Medical School, Lancaster University, Lancaster, UK"},{"name":"Respiratory Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathon","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Stockport NHS Foundation Trust, Stockport, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethan","family":"Powell","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyan M","family":"Kyi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Sou","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2942-6489","authenticated-orcid":false,"given":"Gareth Edward","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Bolton NHS Foundation Trust, Bolton, UK"},{"name":"Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilanka","family":"Tilakaratne","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Bolton NHS Foundation Trust, Bolton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conal","family":"Hayton","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK"},{"name":"School of Medical Sciences, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trishala","family":"Raj","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vi","family":"Truong","sequence":"additional","affiliation":[{"name":"Manchester Royal Infirmary, Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nashwah","family":"Ismail","sequence":"additional","affiliation":[{"name":"Manchester Royal Infirmary, Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nawat","family":"Khanijoun","sequence":"additional","affiliation":[{"name":"Manchester Royal Infirmary, Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Hardy","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Aslam","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahum","family":"Sohail","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahzaib","family":"Babar","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amsal","family":"Amjad","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naayaab","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Regan","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oby","family":"Okpala","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragavilasini","family":"Suresh","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome","family":"Mcintosh","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Gadoud","sequence":"additional","affiliation":[{"name":"Lancaster Medical School, Lancaster University, Lancaster, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Gatheral","sequence":"additional","affiliation":[{"name":"Respiratory Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK"},{"name":"The Pears Cumbria School of Medicine, Imperial College London, Carlisle, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georges","family":"Ng Man Kwong","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"2026040308251627000_13.1.e004017.1","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00009113"},{"key":"2026040308251627000_13.1.e004017.2","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0077-2018"},{"key":"2026040308251627000_13.1.e004017.3","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12931-020-01335-x","article-title":"Hospitalisation patterns of patients with interstitial lung disease in the light of comorbidities and medical treatment - a German claims data analysis","volume":"21","author":"W\u00e4lscher","year":"2020","journal-title":"Respir Res"},{"key":"2026040308251627000_13.1.e004017.4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12931-023-02588-y","article-title":"Hospitalisation patterns in interstitial lung diseases: data from the EXCITING-ILD registry","volume":"25","author":"Buschulte","year":"2024","journal-title":"Respir Res"},{"key":"2026040308251627000_13.1.e004017.5","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2017.00176"},{"key":"2026040308251627000_13.1.e004017.6","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201604-0801CI"},{"key":"2026040308251627000_13.1.e004017.7","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-49125-x"},{"key":"2026040308251627000_13.1.e004017.8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0242860","article-title":"Causes of acute respiratory hospitalizations predict survival in fibrosing interstitial lung diseases","volume":"15","author":"Salonen","year":"2020","journal-title":"PLoS ONE"},{"key":"2026040308251627000_13.1.e004017.9","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000023143","article-title":"A retrospective study of in-hospital mortality in patients with idiopathic pulmonary fibrosis between 2015 and 2018","volume":"99","author":"Durheim","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"2026040308251627000_13.1.e004017.10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s42358-023-00343-x","article-title":"The impact of hospitalization on mortality in patients with connective tissue disease-associated interstitial lung disease: a medical records review study","volume":"64","author":"Korogodina","year":"2024","journal-title":"Adv Rheumatol"},{"key":"2026040308251627000_13.1.e004017.11","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s12325-015-0249-6","article-title":"Development of a Consensus Statement for the Definition, Diagnosis, and Treatment of Acute Exacerbations of Idiopathic Pulmonary Fibrosis Using the Delphi Technique","volume":"32","author":"Maher","year":"2015","journal-title":"Adv Ther"},{"key":"2026040308251627000_13.1.e004017.12","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/S2213-2600(21)00354-4","article-title":"Cyclophosphamide added to glucocorticoids in acute exacerbation of idiopathic pulmonary fibrosis (EXAFIP): a randomised, double-blind, placebo-controlled, phase 3 trial","volume":"10","author":"Naccache","year":"2022","journal-title":"Lancet Respir Med"},{"key":"2026040308251627000_13.1.e004017.13","doi-asserted-by":"publisher","DOI":"10.1080\/17476348.2020.1724096"},{"key":"2026040308251627000_13.1.e004017.14","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01760-2019"},{"key":"2026040308251627000_13.1.e004017.15","unstructured":"Office for National Statistics . Census output area population estimates \u2013 North West, England (supporting information). 2020. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/datasets\/censusoutputareaestimatesinthenorthwestregionofengland"},{"key":"2026040308251627000_13.1.e004017.16","doi-asserted-by":"crossref","first-page":"184","DOI":"10.4324\/9781315775203-11","article-title":"Regulation (EU) 2016\/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95\/46\/EC (General Da)","volume":"2014","author":"Baudot","year":"2017","journal-title":"Routledge Companion to Crit Account"},{"key":"2026040308251627000_13.1.e004017.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2024-002368","article-title":"Research priorities for progressive pulmonary fibrosis in the UK","volume":"11","author":"Fabbri","year":"2024","journal-title":"BMJ Open Respir Res"},{"key":"2026040308251627000_13.1.e004017.18","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"2026040308251627000_13.1.e004017.19","unstructured":"Ministry of Housing Communities and Local Government . English indices of deprivation 2019. 2019. Available: https:\/\/www.gov.uk\/government\/statistics\/english-indices-of-deprivation-2019"},{"key":"2026040308251627000_13.1.e004017.20","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0072-2023"},{"key":"2026040308251627000_13.1.e004017.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2022-001202","article-title":"Neutrophil lymphocyte ratio as an indicator for disease progression in Idiopathic Pulmonary Fibrosis","volume":"9","author":"Achaiah","year":"2022","journal-title":"BMJ Open Respir Res"},{"key":"2026040308251627000_13.1.e004017.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2015.12.026"},{"key":"2026040308251627000_13.1.e004017.23","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00159709"},{"key":"2026040308251627000_13.1.e004017.24","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1159\/000331458","article-title":"The challenge of acute exacerbation of pulmonary fibrosis","volume":"83","author":"Antoniou","year":"2012","journal-title":"Respiration"},{"key":"2026040308251627000_13.1.e004017.25","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s12931-019-1037-7","article-title":"Differing severities of acute exacerbations of idiopathic pulmonary fibrosis (IPF): insights from the INPULSIS\u00ae trials","volume":"20","author":"Kreuter","year":"2019","journal-title":"Respir Res"},{"key":"2026040308251627000_13.1.e004017.26","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2023-001997","article-title":"Clinical manifestations and prognostic factors analysis of patients hospitalised with acute exacerbation of idiopathic pulmonary fibrosis and other interstitial lung diseases","volume":"11","author":"Ba","year":"2024","journal-title":"BMJ Open Resp Res"},{"key":"2026040308251627000_13.1.e004017.27","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00158-2025","article-title":"Update of the international multidisciplinary classification of the interstitial pneumonias: an ERS\/ATS statement","volume":"66","author":"Ryerson","year":"2025","journal-title":"Eur Respir J"},{"key":"2026040308251627000_13.1.e004017.28","doi-asserted-by":"crossref","DOI":"10.1016\/j.rmed.2021.106400","article-title":"Characteristics and evaluation of acute exacerbations in chronic interstitial lung diseases","volume":"183","author":"Kershaw","year":"2021","journal-title":"Respir Med"},{"key":"2026040308251627000_13.1.e004017.29","doi-asserted-by":"crossref","first-page":"21580","DOI":"10.1038\/s41598-025-08969-1","article-title":"Prognostic significance of acute exacerbations and usual interstitial pneumonia in fibrotic interstitial lung disease","volume":"15","author":"Zhang","year":"2025","journal-title":"Sci Rep"},{"key":"2026040308251627000_13.1.e004017.30","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0071-2018"},{"key":"2026040308251627000_13.1.e004017.31","doi-asserted-by":"publisher","DOI":"10.1136\/thorax-2024-222636"},{"key":"2026040308251627000_13.1.e004017.32","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-14-1"},{"key":"2026040308251627000_13.1.e004017.33","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/S2213-2600(17)30383-1","article-title":"Palliative care in interstitial lung disease: living well","volume":"5","author":"Kreuter","year":"2017","journal-title":"Lancet Respir Med"},{"key":"2026040308251627000_13.1.e004017.34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2021-003249"},{"key":"2026040308251627000_13.1.e004017.35","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-070513","article-title":"Exploration of the unmet needs of patients diagnosed with idiopathic pulmonary fibrosis: a scoping review protocol","volume":"13","author":"Bramhill","year":"2023","journal-title":"BMJ Open"},{"key":"2026040308251627000_13.1.e004017.36","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.02014-2022","article-title":"European Respiratory Society clinical practice guideline: palliative care for people with COPD or interstitial lung disease","volume":"62","author":"Janssen","year":"2023","journal-title":"Eur Respir J"},{"key":"2026040308251627000_13.1.e004017.37","unstructured":"National Institute for Health and Care Excellence . Idiopathic pulmonary fibrosis in adults. 2015."},{"key":"2026040308251627000_13.1.e004017.38","unstructured":"British Thoracic Society . 16. BTS ILD registry annual report 2024. 2025.1\u201339."},{"key":"2026040308251627000_13.1.e004017.39","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2018-000360","article-title":"Specialist palliative care, psychology, interstitial lung disease (ILD) multidisciplinary team meeting: a novel model to address palliative care needs","volume":"5","author":"Barratt","year":"2018","journal-title":"BMJ Open Resp Res"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2025-004017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T15:25:24Z","timestamp":1775229924000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2025-004017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,4,3]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjresp-2025-004017"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2025-004017","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}