Whether acute respiratory failure in patients with interstitial lung disease is reversible remains uncertain. Consequently, indications for extracorporeal membrane oxygenation in these patients are still controversial, except as a bridge to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation. In this case–control study using the Japanese Diagnosis Procedure Combination database, hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation from 2010 to 2017 were reviewed. Patients’ characteristics and treatment regimens were compared between survivors and non-survivors to identify prognostic factors. To avoid selection biases, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded. A total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included. Their in-hospital mortality was 74.4% (122/164). Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently, but macrolides and anti-influenza drugs less frequently. On multivariate analysis, the following factors were associated with in-hospital mortality: advanced age (odds ratio [OR] 1.043; 95% confidence interval [CI] 1.009–1.078), non-use of macrolides (OR 0.305; 95% CI 0.134–0.698), and use of antifungal drugs (OR 2.416; 95% CI 1.025–5.696). Approximately three-quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis.

中文翻译：

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体外膜肺氧合治疗急性呼吸衰竭伴间质性肺病的疗效：日本全国病例对照数据集研究

间质性肺病患者的急性呼吸衰竭是否可逆仍不确定。因此，除了作为肺移植的桥梁外，这些患者的体外膜肺氧合指征仍然存在争议。本研究的目的是阐明接受体外膜肺氧合的间质性肺病患者的住院死亡率和预后因素。在这项使用日本诊断程序组合数据库的病例对照研究中，回顾了 2010 年至 2017 年接受有创机械通气和体外膜肺氧合的住院间质性肺病患者。比较幸存者和非幸存者的患者特征和治疗方案，以确定预后因素。为了避免选择偏差，排除接受体外膜肺氧合作为肺移植过渡治疗的患者。共纳入 164 名接受体外膜肺氧合的间质性肺病患者。他们的住院死亡率为 74.4% (122/164)。与幸存者相比，非幸存者年龄较大，接受大剂量环磷酰胺、蛋白酶抑制剂和抗真菌药物的频率更高，但大环内酯类药物和抗流感药物的频率较低。在多变量分析中，以下因素与住院死亡率相关：高龄（优势比 [OR] 1.043；95% 置信区间 [CI] 1.009-1.078），未使用大环内酯类药物（OR 0.305；95% CI 0.134 –0.698）和抗真菌药物的使用（OR 2.416；95% CI 1.025–5.696）。大约四分之三接受体外膜肺氧合的间质性肺病患者在医院死亡。此外，发现高龄、不使用大环内酯类药物和使用抗真菌药物与预后不良有关。