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Medication Regimen Complexity Score as an Indicator of Fluid Balance in Critically Ill Patients
William J Olney1, Aaron M Chase2, Sarah A Hannah3
1Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY, USA.
Background:
Critically ill patients are at increased risk for fluid overload, but objective prediction tools to guide clinical decision-making are lacking. The MRC-ICU scoring tool is an objective tool for measuring medication regimen complexity.
Objective:
To evaluate the relationship between MRC-ICU score and fluid overload in critically ill patients.
Methods:
In this multi-center, retrospective, observational study, the relationship between MRC-ICU and the risk of fluid overload was examined. Patient demographics, fluid balance at day 3 of ICU admission, MRC-ICU score at 24 hours, and clinical outcomes were collected from the medical record. The primary outcome was relationship between MRC-ICU and fluid overload. To analyze this, MRC-ICU scores were divided into tertiles (low, moderate, high), and binary logistic regression was performed. Linear regression was performed to determine variables associated with positive fluid balance.
Results:
A total of 125 patients were included. The median MRC-ICU score at 24 hours of ICU admission for low, moderate, and high tertiles were 9, 15, and 21, respectively. For each point increase in MRC-ICU, a 13% increase in the likelihood of fluid overload was observed (OR 1.128, 95% CI 1.028-1.238, p = 0.011). The MRC-ICU score was positively associated with fluid balance at day 3 (β-coefficient 218.455, 95% CI 94.693-342.217, p = 0.001) when controlling for age, gender, and SOFA score.
Conclusions:
Medication regimen complexity demonstrated a weakly positive correlation with fluid overload in critically ill patients. Future studies are necessary to establish the MRC-ICU as a predictor to identify patients at risk of fluid overload.
Insights
Medication regimen complexity, measured by the MRC-ICU score, showed a weak link to fluid overload in critically ill patients. Further research is needed to confirm its predictive value.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Clinical Outcomes Research
Background:
- Critically ill patients face a high risk of fluid overload.
- Objective tools for predicting fluid overload are currently lacking.
- The MRC-ICU score measures medication regimen complexity.
Purpose of the Study:
- To assess the association between the MRC-ICU score and fluid overload in critically ill patients.
- To determine if medication regimen complexity predicts fluid overload risk.
Main Methods:
- A multi-center, retrospective, observational study.
- Collected data on patient demographics, fluid balance, MRC-ICU scores, and outcomes.
- Analyzed the relationship using logistic and linear regression, dividing MRC-ICU scores into tertiles.
Main Results:
- A 13% increased likelihood of fluid overload for each MRC-ICU score point increase (OR 1.128).
- MRC-ICU score positively correlated with fluid balance at day 3 (β=218.455), even after controlling for other factors.
- Median MRC-ICU scores were 9, 15, and 21 for low, moderate, and high tertiles, respectively.
Conclusions:
- Medication regimen complexity (MRC-ICU score) has a weakly positive correlation with fluid overload.
- The MRC-ICU score may serve as a potential predictor for fluid overload risk in critically ill patients.
- Further investigation is required to validate the MRC-ICU score's predictive capability.
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