评估药物治疗方案的复杂性作为死亡率的预测指标
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.
Scientific reports
|July 4, 2023
概括
在ICU中药物治疗方案的复杂性,通过MRC-ICU得分来衡量,与更高的医院死亡率相关. 将这种复杂度得分添加到现有模型中,在预测患者存活率方面提供了适度的改进.
科学领域:
- 临界护理医学 临界护理医学
- 药物经济学 药物经济学
- 健康 结果 研究 研究 结果
背景情况:
- 药物治疗方案的复杂性是重症监护室 (ICU) 中日益关注的问题.
- 药物治疗方案复杂性-重症监护室 (MRC-ICU) 评分是一个新的指数来量化这种复杂性.
- 对于医院死亡率的MRC-ICU得分的预测价值仍然不清楚.
研究的目的:
- 描述MRC-ICU得分,疾病严重程度和医院死亡率之间的关联.
- 评估将MRC-ICU得分纳入现有的医院死亡率预测模型中的增量效益.
主要方法:
- 一个单一中心的观察队列研究包括991名成年ICU患者入院至少24小时.
- 每天使用MRC-ICU得分来评估药物治疗方案的复杂性.
- 医院死亡率预测模型使用接收器运行特征 (AUROC) 曲线下的面积进行了评估,比较了带有和没有MRC-ICU得分的模型,以及APACHE II和SOFA得分.
主要成果:
- 平均24小时MRC-ICU得分每增加1个点,就会增加5%的医院死亡率 (OR1.05,p=0.002).
- 一个结合MRC-ICU,APACHE II和SOFA得分的预测模型实现了死亡率的AUROC为0.81.
- 一个仅使用APACHE II和SOFA分数的模型,死亡率的AUROC为0.76.
结论:
- 通过MRC-ICU得分来衡量药物治疗方案的复杂性,与增加的医院死亡率显著相关.
- 在MRC-ICU得分提供了适度但显著的改善在医院死亡率的预测,当添加到已建立的疾病严重程度得分.
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