S T Vaara1, M Reinikainen, K-M Kaukonen, V Pettilä. 1. Intensive Care Units, Division of Anaesthesia and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, Finland. suvi.vaara@helsinki.fi
Abstract
BACKGROUND: We aimed to reveal whether the size of an intensive care unit (ICU) or its annual case volume of patients treated with renal replacement therapy (RRT) for acute kidney injury (AKI) is associated with hospital mortality. METHODS: This was a retrospective cohort study in the Finnish Intensive Care Consortium (FICC) database in 2007-2008. We divided the 23 FICC-member ICUs first into small or large according to ICU size, and second into low, medium, or high-volume tertiles according to annual case volume of patients with RRT. We compared crude hospital mortality, Simplified Acute Physiology Score (SAPS) II-, and case-mix-adjusted hospital mortality in small vs. large ICUs and in low- or medium-volume vs. high-volume ICUs. RESULTS: The median (interquartile range) annual case volume of patients with RRT for AKI per one ICU was 25 (19-45). Patients in small or low-volume ICUs were older and less severely ill. Crude and SAPS II -adjusted hospital mortality rates were significantly higher in small ICUs but not significantly different in case volume tertiles. After adjusting for age, severity of illness, intensity of care, propensity to receive RRT, and day of RRT initiation, treatment in low or medium volume ICUs was associated with an increased risk for hospital mortality. CONCLUSIONS: Crude and adjusted hospital mortality rates of patients treated with RRT for AKI were higher in small ICUs. Patients treated in high-volume ICUs had a decreased adjusted risk for hospital mortality compared to those in low-or medium volume ICUs.
BACKGROUND: We aimed to reveal whether the size of an intensive care unit (ICU) or its annual case volume of patients treated with renal replacement therapy (RRT) for acute kidney injury (AKI) is associated with hospital mortality. METHODS: This was a retrospective cohort study in the Finnish Intensive Care Consortium (FICC) database in 2007-2008. We divided the 23 FICC-member ICUs first into small or large according to ICU size, and second into low, medium, or high-volume tertiles according to annual case volume of patients with RRT. We compared crude hospital mortality, Simplified Acute Physiology Score (SAPS) II-, and case-mix-adjusted hospital mortality in small vs. large ICUs and in low- or medium-volume vs. high-volume ICUs. RESULTS: The median (interquartile range) annual case volume of patients with RRT for AKI per one ICU was 25 (19-45). Patients in small or low-volume ICUs were older and less severely ill. Crude and SAPS II -adjusted hospital mortality rates were significantly higher in small ICUs but not significantly different in case volume tertiles. After adjusting for age, severity of illness, intensity of care, propensity to receive RRT, and day of RRT initiation, treatment in low or medium volume ICUs was associated with an increased risk for hospital mortality. CONCLUSIONS: Crude and adjusted hospital mortality rates of patients treated with RRT for AKI were higher in small ICUs. Patients treated in high-volume ICUs had a decreased adjusted risk for hospital mortality compared to those in low-or medium volume ICUs.
Authors: Milo Engoren; Michael D Maile; Michael Heung; James M Blum; Ross Blank; Lena M Napolitano; Pauline K Park; Krishnan Raghavendran; Elizabeth S Jewell; Craig Meldrum Journal: J Intensive Care Soc Date: 2019-12-05
Authors: Shruti Gupta; Steven G Coca; Lili Chan; Michal L Melamed; Samantha K Brenner; Salim S Hayek; Anne Sutherland; Sonika Puri; Anand Srivastava; Amanda Leonberg-Yoo; Alexandre M Shehata; Jennifer E Flythe; Arash Rashidi; Edward J Schenck; Nitender Goyal; S Susan Hedayati; Rajany Dy; Anip Bansal; Ambarish Athavale; H Bryant Nguyen; Anitha Vijayan; David M Charytan; Carl E Schulze; Min J Joo; Allon N Friedman; Jingjing Zhang; Marie Anne Sosa; Eric Judd; Juan Carlos Q Velez; Mary Mallappallil; Roberta E Redfern; Amar D Bansal; Javier A Neyra; Kathleen D Liu; Amanda D Renaghan; Marta Christov; Miklos Z Molnar; Shreyak Sharma; Omer Kamal; Jeffery Owusu Boateng; Samuel A P Short; Andrew J Admon; Meghan E Sise; Wei Wang; Chirag R Parikh; David E Leaf Journal: J Am Soc Nephrol Date: 2020-10-16 Impact factor: 10.121