In-hospital Mortality Associated with Granulomatosis with Polyangiitis and Microscopic Polyangiitis Complicated with Respiratory Failure

Francisco F Costa Filho; Vanita Motiani; Alan Furlan; Austin S. Brubaker; Pranav Kidambi; Philip Kroth

doi:10.36141/svdld.2026.18438

Authors

Francisco F Costa Filho Pulmonary and Critical Care Fellowship, Corewell Health West, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
Vanita Motiani Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
Alan Furlan Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
Austin S. Brubaker Department of Biomedical Informatics, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
Pranav Kidambi Department of Pulmonary and Critical Care, Corewell Health West, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
Philip Kroth Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA; Department of Biomedical Informatics, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA

Keywords:

ANCA-associated Vasculitis, Granulomatosis with polyangiitis, Microscopic polyangiitis, National Inpatient Sample database, Respiratory Failure

Abstract

Background and aim: Our study aimed to determine the in-hospital mortality rate among granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) hospitalizations complicated with acute respiratory failure (ARF) in the US and determine prognostic factors during hospitalization.

Method: We performed a retrospective cohort analysis utilizing the National In-patient Sample (NIS) database to identify hospitalizations of patients with GPA or MPA associated with ARF from 2016 to 2021. The outcomes included in-hospital mortality, requirement of invasive procedures, and hospital length of stay. Univariable and multivariable analysis were used to identify prognostic factors associated with in-hospital mortality.

Results: We identified 21,430 weighted (4,283 unweighted) hospitalizations with diagnosis of GPA or MPA associated with ARF in the United States from 2016 to 2021. 78.3% of those were diagnosed with GPA, 19.2% with MPA, and 2.5% with both ICD-10 codes. The mean age was 63.7 years, 53.6% were female, and 73.3% were White. The rate of hemodialysis was 21.5%, plasmapheresis 7.4%, and extracorporeal membrane oxygenation in 0.5% of hospitalizations. The overall in-hospital mortality was 15.4%, compared to 35.9% in the subgroup requiring invasive mechanical ventilation (IMV). Independent prognostic factors associated with increased in-hospital mortality were higher age, acute kidney injury (AKI), sepsis, requirement of non-invasive mechanical ventilation, interstitial lung disease (ILD), history of stroke, shock, and requirement of IMV.

Conclusion: GPA or MPA hospitalizations complicated with ARF were found to be associated with a high in-hospital mortality rate. At hospital-level prognostication assessment, we found that higher age, AKI, sepsis, shock, history of ILD, history of stroke, and requirement of mechanical ventilation were independently associated with increased in-hospital mortality.

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