An adjudication algorithm for respiratory-related hospitalisation in idiopathic pulmonary fibrosis

Paul Ford, Michael Kreuter, Kevin K. Brown, Wim A. Wuyts, Marlies Wijsenbeek, Dominique Israël-Biet, Richard Hubbard, Steven D. Nathan, Hilario Nunes, Bjorn Penninckx, Niyati Prasad, Ineke Seghers, Paolo Spagnolo, Nadia Verbruggen, Nik Hirani, Juergen Behr, Robert J. Kaner, Toby M. Maher

Research output: Journal PublicationArticlepeer-review


Background There is no standard definition of respiratory-related hospitalisation, a common end-point in idiopathic pulmonary fibrosis (IPF) clinical trials. As diverse aetiologies and complicating comorbidities can present similarly, external adjudication is sometimes employed to achieve standardisation of these events. Methods An algorithm for respiratory-related hospitalisation was developed through a literature review of IPF clinical trials with respiratory-related hospitalisation as an end-point. Experts reviewed the algorithm until a consensus was reached. The algorithm was validated using data from the phase 3 ISABELA trials ( identifiers NCT03711162 and NCT03733444), by assessing concordance between nonadjudicated, investigator-defined, respiratory-related hospitalisations and those defined by the adjudication committee using the algorithm. Results The algorithm classifies respiratory-related hospitalisation according to cause: extraparenchymal (worsening respiratory symptoms due to left heart failure, volume overload, pulmonary embolism, pneumothorax or trauma); other (respiratory tract infection, right heart failure or exacerbation of COPD); “definite” acute exacerbation of IPF (AEIPF) (worsening respiratory symptoms within 1 month, with radiological or histological evidence of diffuse alveolar damage); or “suspected” AEIPF (as for “definite” AEIPF, but with no radiological or histological evidence of diffuse alveolar damage). Exacerbations (“definite” or “suspected”) with identified triggers (infective, post-procedural or traumatic, drug toxicity-or aspiration-related) are classed as “known AEIPF”; “idiopathic AEIPF” refers to exacerbations with no identified trigger. In the ISABELA programme, there was 94% concordance between investigator-and adjudication committee-determined causes of respiratory-related hospitalisation. Conclusion The algorithm could help to ensure consistency in the reporting of respiratory-related hospitalisation in IPF trials, optimising its utility as an end-point.

Original languageEnglish
Article number00636-2023
JournalERJ Open Research
Issue number1
Publication statusPublished - 1 Jan 2024
Externally publishedYes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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