Lecuyer L, Chevret S, Guidet B, Aegerter P, Martel P, Schlemmer B, Azoulay E
Intensive Care Unit and Biostatistics Dept, Saint-Louis Teaching Hospital, Paris, France.
Eur Respir J. 2008 Sep;32(3):748-54. doi: 10.1183/09031936.00142907. Epub 2008 Apr 30.
High case volume is associated with improved survival in medical and surgical conditions. The present study sought to determine whether intensive care unit (ICU) case volume was associated with survival of critically ill patients with haematological malignancies and acute respiratory failure (ARF). A regional database containing data from 1,753 haematological patients with ARF admitted to 28 medical ICUs from 1997 to 2004 was used. Multivariate analysis using mixed models was performed to adjust for severity of illness and other confounding factors, including a propensity score that incorporates differences between ICUs with different case volumes. The three case volume tertiles were: low volume (<12 admissions per year), intermediate volume (12-30 admissions per year), and high volume (>30 admissions per year). In univariate analyses, ICU case volume was not associated with ICU mortality. After adjusting for prognostic factors for ICU mortality and the propensity score, patients in high-volume ICUs had lower mortality than other patients. A case volume increase of one admission per year led to a significant mortality reduction with an odds ratio of 0.98 (95% confidence limits 0.97-0.99). Mortality was independently associated with severity of organ dysfunction. In intensive care units admitting larger numbers of critically ill haematological patients with acute respiratory failure, mortality was lower than in other intensive care units. The mechanisms of the relationship between volume and outcome among haematological patients with acute respiratory deserve additional studies.
高病例数与内科和外科疾病患者生存率的提高相关。本研究旨在确定重症监护病房（ICU）的病例数是否与患有血液系统恶性肿瘤并伴有急性呼吸衰竭（ARF）的危重症患者的生存率相关。我们使用了一个区域数据库，该数据库包含了1997年至2004年期间28个内科ICU收治的1753例患有ARF的血液系统疾病患者的数据。采用混合模型进行多变量分析，以调整疾病严重程度和其他混杂因素，包括纳入不同病例数的ICU之间差异的倾向评分。三个病例数三分位数分别为：低病例数（每年入院<12例）、中等病例数（每年入院12 - 30例）和高病例数（每年入院>30例）。在单变量分析中，ICU病例数与ICU死亡率无关。在调整了ICU死亡率的预后因素和倾向评分后，高病例数ICU的患者死亡率低于其他患者。每年病例数增加一例导致死亡率显著降低，优势比为0.98（95%置信区间0.97 - 0.99）。死亡率与器官功能障碍的严重程度独立相关。在收治大量患有急性呼吸衰竭的危重症血液系统疾病患者的重症监护病房中，死亡率低于其他重症监护病房。急性呼吸衰竭血液系统疾病患者中病例数与预后之间关系的机制值得进一步研究。
