Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
Crit Care Med. 2011 Nov;39(11):2470-7. doi: 10.1097/CCM.0b013e3182257631.
Evidence suggests that patients requiring high-risk procedures benefit from care at institutions providing a large volume of these procedures. Our objective was to determine whether there is a volume-outcome relationship among intensive care unit patients receiving renal support therapy in two different healthcare systems (France and the United States).
Retrospective cohort study.
Two multicenter intensive care unit databases: CUB-Réa (France) and Project IMPACT (United States).
All nonsurgical adults requiring renal support therapy from 1997 to 2007 were included.
None.
We assessed association of annual renal support therapy volume with intensive care unit and hospital mortality using multivariable modeling, accounting for clustering and adjusting for age, comorbidities, admitting diagnosis, illness severity, pre-intensive care unit length of stay, admission source, and hospital and intensive care unit characteristics. Our final cohorts were 9,449 patients treated in 32 intensive care units in CUB-Réa and 3,498 patients treated in 76 intensive care units in Project IMPACT. Patient demographics did not differ between cohorts. Renal support therapy delivery varied widely across intensive care units (3-129 patients per year in CUB-Réa, 1-66 in Project IMPACT). Overall intensive care unit and hospital mortality rates were 45% and 49% in CUB-Réa and 34% and 47% in Project IMPACT. After adjustment for patient, intensive care unit, and hospital characteristics, there was no association between renal support therapy volume and intensive care unit or hospital mortality whether we treated volume as a continuous measure or quartiles. Higher renal support therapy volume was associated with shorter length of stay only in CUB-Réa.
There is a large variation in annual renal support therapy volume across intensive care units in France and the United States but no association of higher volumes with improved outcomes.
有证据表明，接受高风险手术的患者在大量开展此类手术的医疗机构中接受治疗将获益。我们的目的是确定在两个不同的医疗体系（法国和美国）中，接受肾脏支持治疗的重症监护病房（ICU）患者的治疗量与预后之间是否存在关联。
回顾性队列研究。
两个多中心 ICU 数据库：CUB-Réa（法国）和 Project IMPACT（美国）。
纳入 1997 年至 2007 年间所有非外科成年患者，他们需要接受肾脏支持治疗。
无。
我们使用多变量模型评估了每年肾脏支持治疗量与 ICU 和医院死亡率之间的关联，该模型考虑了聚类因素，并针对年龄、合并症、入院诊断、疾病严重程度、入 ICU 前的住院时间、入院来源以及医院和 ICU 特征进行了调整。我们的最终队列包括来自 CUB-Réa 的 32 个 ICU 的 9449 例患者和来自 Project IMPACT 的 76 个 ICU 的 3498 例患者。两组患者的人口统计学特征无差异。肾脏支持治疗的实施在 ICU 之间差异很大（CUB-Réa 为每年 3-129 例患者，Project IMPACT 为 1-66 例患者）。CUB-Réa 和 Project IMPACT 的 ICU 及医院总死亡率分别为 45%和 49%、34%和 47%。在调整患者、ICU 和医院特征后，无论是将治疗量视为连续测量值还是四分之一分位数，肾脏支持治疗量与 ICU 或医院死亡率之间均无关联。只有在 CUB-Réa 中，较高的肾脏支持治疗量与较短的住院时间相关。
法国和美国的 ICU 中每年肾脏支持治疗量差异很大，但较高的治疗量与改善预后无关。
