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Evaluating the Medication Regimen Complexity Score as a Predictor of Clinical Outcomes in the Critically Ill
Mohammad A Al-Mamun1, Jacob Strock2, Yushuf Sharker3
1School of Pharmacy, University of West Virginia, 706 Health Sciences Ctr S, Morgantown, WV 26506, USA.
Abstract:
Background: Medication Regimen Complexity (MRC) refers to the combination of medication classes, dosages, and frequencies. The objective of this study was to examine the relationship between the scores of different MRC tools and the clinical outcomes. Methods: We conducted a retrospective cohort study at Roger William Medical Center, Providence, Rhode Island, which included 317 adult patients admitted to the intensive care unit (ICU) between 1 February 2020 and 30 August 2020. MRC was assessed using the MRC Index (MRCI) and MRC for the Intensive Care Unit (MRC-ICU). A multivariable logistic regression model was used to identify associations among MRC scores, clinical outcomes, and a logistic classifier to predict clinical outcomes. Results: Higher MRC scores were associated with increased mortality, a longer ICU length of stay (LOS), and the need for mechanical ventilation (MV). MRC-ICU scores at 24 h were significantly (p < 0.001) associated with increased ICU mortality, LOS, and MV, with ORs of 1.12 (95% CI: 1.06−1.19), 1.17 (1.1−1.24), and 1.21 (1.14−1.29), respectively. Mortality prediction was similar using both scoring tools (AUC: 0.88 [0.75−0.97] vs. 0.88 [0.76−0.97]. The model with 15 medication classes outperformed others in predicting the ICU LOS and the need for MV with AUCs of 0.82 (0.71−0.93) and 0.87 (0.77−0.96), respectively. Conclusion: Our results demonstrated that both MRC scores were associated with poorer clinical outcomes. The incorporation of MRC scores in real-time therapeutic decision making can aid clinicians to prescribe safer alternatives.
Insights
High medication regimen complexity (MRC) scores in ICU patients correlate with increased mortality, longer hospital stays, and greater need for mechanical ventilation. These findings highlight MRC
Area of Science:
- Pharmacology and Clinical Pharmacy
- Critical Care Medicine
- Health Outcomes Research
Background:
- Medication Regimen Complexity (MRC) is defined by the combination of medication classes, dosages, and frequencies.
- Understanding the impact of MRC on patient outcomes is crucial for optimizing pharmacotherapy.
- Existing MRC tools require evaluation for their predictive value in critical care settings.
Purpose of the Study:
- To investigate the association between different Medication Regimen Complexity (MRC) scoring tools and clinical outcomes in intensive care unit (ICU) patients.
- To compare the predictive performance of MRC Index (MRCI) and MRC for the Intensive Care Unit (MRC-ICU) scores.
- To assess the utility of MRC scores in predicting ICU mortality, length of stay (LOS), and need for mechanical ventilation (MV).
Main Methods:
- Retrospective cohort study involving 317 adult ICU patients.
- Assessment of MRC using the MRC Index (MRCI) and MRC for the Intensive Care Unit (MRC-ICU).
- Multivariable logistic regression and logistic classifier models were employed to analyze associations and predict outcomes.
Main Results:
- Higher MRC scores were significantly associated with increased ICU mortality, prolonged ICU LOS, and higher rates of MV.
- MRC-ICU scores at 24 hours demonstrated significant associations with increased ICU mortality (OR: 1.12), LOS (OR: 1.17), and MV (OR: 1.21).
- A model incorporating 15 medication classes showed strong predictive performance for ICU LOS (AUC: 0.82) and MV (AUC: 0.87).
Conclusions:
- Both MRCI and MRC-ICU scores are linked to adverse clinical outcomes in ICU patients.
- MRC scores can serve as valuable tools for predicting patient outcomes and guiding clinical decisions.
- Integrating MRC assessment into real-time decision-making may help clinicians select safer medication alternatives.
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