Medication Regimen Complexity Score as an Indicator of Fluid Balance in Critically Ill Patients

Abstract

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.

Cluster analysis driven by unsupervised latent feature learning of intensive care unit medications to identify novel pharmaco-phenotypes of critically ill patients

“…24 We assumed homogeneity across medication regimens; however, in practice this may be a highly complex and noisy interaction: therefore, in future work, we seek to utilize Trust Discover platforms to generalize pharmacotherapy pro les that are normalized independent of clinician and institutional bias. 49 Finally, causal inference cannot be assessed by the current study, so it is unknown whether the high mortality observed in Patient Cluster 4 was partly caused by the unique distribution of pharmacophenotypes versus other factors (although notably, Cluster 4 shared similarities among groups). Even with these limitations, this analysis marks the rst time the complete medication pro le has been incorporated into outcomes analysis for ICU patients.…”

Early Diuretics for De-resuscitation in Septic Patients With Left Ventricular Dysfunction

“… 32 Notably, positive fluid balance may serve as an “intervenable” patient event during an ICU stay that pharmacists can target and prevent, as diuretics represent a readily available strategy. 33 …”

“…32 Notably, positive fluid balance may serve as an "intervenable" patient event during an ICU stay that pharmacists can target and prevent, as diuretics represent a readily available strategy. 33 There are no studies about early diuresis in a septic HF population, and the timing of de-resuscitation remains debated. Though the 2021 Surviving Sepsis Guidelines emphasize 30 mL/kg given within the first 3 hours, much less is known regarding when to initiate diuresis.…”

Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score*

“…The studies that chronicle the development and evaluation of the MRC-ICU are summarized in Supplemental Digital Content -Table 2 (http://links.lww.com/CCM/H141). The primary limitation of all MRC-ICU evaluations to date has been the small sample and one (or two) center designs that inherently lack the robust external validity necessary for widespread use (6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

“…The Medication Regimen Complexity-ICU (MRC-ICU) scoring tool is the first metric proposed with the specific intention of describing relevant relationships in the optimal critical care pharmacy practice model and has shown early promise at overcoming historical limitations in pilot studies (6)(7)(8)(9)(10)(11)(12)(13). This 37-line item score has been provided in Supplemental Digital Content -Table 1 (http://links.lww.com/CCM/H141).…”