Case mix, outcome and activity for patients admitted to intensive care units requiring chronic renal dialysis: a secondary analysis of the ICNARC Case Mix Programme Database
Case mix, outcome and activity for patients admitted to intensive care units requiring chronic renal dialysis: a secondary analysis of the ICNARC Case Mix Programme Database
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DOI：
10.1186/cc5785
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发表时间：
2007-01-01
期刊：
影响因子：
15.1
通讯作者：
Lipkin, Graham W.
中科院分区：
文献类型：
--
作者：
Hutchison, Colin A.;Crowe, Alex V.;Lipkin, Graham W.
本报告描述了因终末期肾衰竭（ESRF）而需要既往慢性肾透析的患者入住重症监护病房（icu）的病例组合、结果和活动，并调查了病例组合因素对结果的影响。方法：本研究是对高质量临床数据库的二次分析，即重症监护国家审计与研究中心（ICNARC）病例组合规划数据库，该数据库包括1995年至2004年英格兰、威尔士和北爱尔兰170个成人重症监护病房的276,731例入院病例。结果在8年的研究期间，1.3% （n = 3420）的ICU患者在入院前接受了慢性肾透析。这代表每100名透析患者年估计有6次住院（32床日）的ICU使用率。ESRF组比无ESRF组更年轻（平均年龄57.3岁比59.5岁），男性更有可能（60.2%比57.9%）。急性生理和慢性健康评估II评分和急性生理评分显示ESRF患者入院时疾病的严重程度更高（平均分别为24.7比16.6和17.2比12.6）。两组患者在ICU的住院时间相当（中位1.9天对1.8天），ESRF组的ICU死亡率仅略有升高（26.3%对20.8%）。然而，ESRF组的总住院时间延长（中位数为25天对17天），住院死亡率增加（45.3%对31.2%），ICU再入院率增加（9.0%对4.7%）。经病例组合调整后的多元logistic回归分析发现，住院死亡率的增加与年龄的增加、急诊手术和非手术病例、入院前心肺复苏和生理规范的极端有关。慢性肾透析相关最终住院死亡率的校正优势比为1.24（95%可信区间1.13 ~ 1.37）。结论：与非ESRF人群相比，英国icu收治的ESRF患者更有可能是男性和年轻的，有医疗入院原因，并且疾病的严重程度更高。两组在ICU的治疗结果相似，但ESRF患者的再入院率更高，ICU后住院时间延长，ICU后住院死亡率增加。这项研究是迄今为止在ICU收治的ESRF患者中规模最大的比较结果分析。它可能有助于告知临床决策和资源需求的患者群体。
Introduction This report describes the case mix, outcome and activity for admissions to intensive care units ( ICUs) of patients who require prior chronic renal dialysis for end-stage renal failure ( ESRF), and investigates the effect of case mix factors on outcome.Methods This was a secondary analysis of a high-quality clinical database, namely the Intensive Care National Audit & Research Centre ( ICNARC) Case Mix Programme Database, which includes 276,731 admissions to 170 adult ICUs across England, Wales and Northern Ireland from 1995 to 2004.Results During the eight year study period, 1.3% ( n = 3,420) of all patients admitted to ICU were receiving chronic renal dialysis before ICU admission. This represents an estimated ICU utilization of six admissions ( 32 bed-days) per 100 dialysis patient-years. The ESRF group was younger ( mean age 57.3 years versus 59.5 years) and more likely to be male ( 60.2% versus 57.9%) than those without ESRF. Acute Physiology and Chronic Health Evaluation II score and Acute Physiology Score revealed greater severity of illness on admission in patients with ESRF ( mean 24.7 versus 16.6 and 17.2 versus 12.6, respectively). Length of stay in ICU was comparable between groups ( median 1.9 days versus 1.8 days) and ICU mortality was only slightly elevated in the ESRF group ( 26.3% versus 20.8%). However, the ESRF group had protracted overall hospital stay ( median 25 days versus 17 days), and increased hospital mortality ( 45.3% versus 31.2%) and ICU readmission ( 9.0% vs. 4.7%). Multiple logistic regression analysis adjusted for case mix identified the increased hospital mortality to be associated with increasing age, emergency surgery and nonsurgical cases, cardiopulmonary resuscitation before ICU admission and extremes of physiological norms. The adjusted odds ratio for ultimate hospital mortality associated with chronic renal dialysis was 1.24 ( 95% confidence interval 1.13 to 1.37).Conclusion Patients with ESRF admitted to UK ICUs are more likely to be male and younger, with a medical cause of admission, and to have greater severity of illness than the non-ESRF population. Outcomes on the ICU were comparable between the two groups, but those patients with ESRF had greater readmission rates, prolonged post-ICU hospital stay and increased post-ICU hospital mortality. This study is by far the largest comparative outcome analysis to date in patients with ESRF admitted to the ICU. It may help to inform clinical decision-making and resource requirements for this patient population.