Evaluation of medication regimen complexity as a predictor for mortality.

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.