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Published on: January 8, 2020
Evaluation of medication regimen complexity as a predictor for mortality
Andrea Sikora1, John W Devlin2,3, Mengyun Yu4
1Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, 1120 15th Street, HM-118, Augusta, GA, 30912, USA. sikora@uga.edu.
Abstract:
While medication regimen complexity, as measured by a novel medication regimen complexity-intensive care unit (MRC-ICU) score, correlates with baseline severity of illness and mortality, whether the MRC-ICU improves hospital mortality prediction is not known. After characterizing the association between MRC-ICU, severity of illness and hospital mortality we sought to evaluate the incremental benefit of adding MRC-ICU to illness severity-based hospital mortality prediction models. This was a single-center, observational cohort study of adult intensive care units (ICUs). A random sample of 991 adults admitted ≥ 24 h to the ICU from 10/2015 to 10/2020 were included. The logistic regression models for the primary outcome of mortality were assessed via area under the receiver operating characteristic (AUROC). Medication regimen complexity was evaluated daily using the MRC-ICU. This previously validated index is a weighted summation of medications prescribed in the first 24 h of ICU stay [e.g., a patient prescribed insulin (1 point) and vancomycin (3 points) has a MRC-ICU = 4 points]. Baseline demographic features (e.g., age, sex, ICU type) were collected and severity of illness (based on worst values within the first 24 h of ICU admission) was characterized using both the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Sequential Organ Failure Assessment (SOFA) score. Univariate analysis of 991 patients revealed every one-point increase in the average 24-h MRC-ICU score was associated with a 5% increase in hospital mortality [Odds Ratio (OR) 1.05, 95% confidence interval 1.02-1.08, p = 0.002]. The model including MRC-ICU, APACHE II and SOFA had a AUROC for mortality of 0.81 whereas the model including only APACHE-II and SOFA had a AUROC for mortality of 0.76. Medication regimen complexity is associated with increased hospital mortality. A prediction model including medication regimen complexity only modestly improves hospital mortality prediction.
Insights
Medication regimen complexity in ICUs, measured by the MRC-ICU score, correlates with higher hospital mortality. Adding this complexity score to existing models offers a modest improvement in predicting patient survival.
Area of Science:
- Critical Care Medicine
- Pharmacoeconomics
- Health Outcomes Research
Background:
- Medication regimen complexity is a growing concern in intensive care units (ICUs).
- The Medication Regimen Complexity-Intensive Care Unit (MRC-ICU) score is a novel index to quantify this complexity.
- The predictive value of the MRC-ICU score for hospital mortality remains unclear.
Purpose of the Study:
- To characterize the association between the MRC-ICU score, severity of illness, and hospital mortality.
- To evaluate the incremental benefit of incorporating the MRC-ICU score into existing hospital mortality prediction models.
Main Methods:
- A single-center, observational cohort study included 991 adult ICU patients admitted for at least 24 hours.
- Medication regimen complexity was assessed daily using the MRC-ICU score.
- Hospital mortality prediction models were evaluated using the area under the receiver operating characteristic (AUROC) curve, comparing models with and without the MRC-ICU score, alongside APACHE II and SOFA scores.
Main Results:
- Each one-point increase in the average 24-hour MRC-ICU score was associated with a 5% increase in hospital mortality (OR 1.05, p=0.002).
- A prediction model incorporating MRC-ICU, APACHE II, and SOFA scores achieved an AUROC of 0.81 for mortality.
- A model using only APACHE II and SOFA scores had an AUROC of 0.76 for mortality.
Conclusions:
- Medication regimen complexity, as measured by the MRC-ICU score, is significantly associated with increased hospital mortality.
- The MRC-ICU score provides a modest but significant improvement in the prediction of hospital mortality when added to established severity-of-illness scores.
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