Christy Forehand, PharmD, BCCCP,FCCM
Critical Care Clinical Pharmacist/PGY2 Critical Care Residency Program Director
Augusta University Medical Center
North Augusta, SC
Disclosure information not submitted.
Hanna Azimi, PharmD
PGY1 Pharmacy Resident
AU Medical Center/University of Georgia College of Pharmacy, United States
Disclosure information not submitted.
Logan Johnson, n/a
Pharmacy student
University of Georgia College of Pharmacy, United States
Disclosure information not submitted.
Emily Loudermilk, n/a
Pharmacy student
University of Georgia College of Pharmacy, United States
Disclosure information not submitted.
Aaron Chase
PGY-2 Critical Care Pharmacy Resident
Augusta University Medical Center
Augusta, Georgia
Disclosure information not submitted.
Andrea Sikora, BCCCP, PharmD
Critial Care Pharmacy Specialist
University of Georgia College of Pharmacy
Augusta, Georgia
Disclosure information not submitted.
Title: Medication Regimen Complexity Score to Predict Inpatient Death in Critically Ill COVID-19 Patients
Introduction: Patient factors linked to increased mortality in COVID-19 include older age, male sex, higher BMI, higher D-dimer, diabetes, and immunosuppression. However, validated tools to predict death or severe outcomes in this patient population are lacking. The sequential organ failure assessment has proved unreliable in predicting death in COVID-19 and was found to be inferior to using age alone. The Medication Regimen Complexity score (MRC-ICU) has been shown to predict hospital length of stay (LOS), inpatient mortality, and patient acuity in a general medical ICU (MICU) population based on the complexity of a patient’s medication regimen at 24 hours. Identifying a validated tool to assist with pharmacy resource allocation to the patients with the highest needs during a patient surge event such as the COVID-19 pandemic is vital. The objective of this study was to identify if a relationship exists between medication regimen complexity, measured by MRC-ICU, and patient outcomes in patients with COVID-19.
Methods: This was a single-center, retrospective chart review of adults with presumed or confirmed positive COVID-19 and admitted to the MICU between September 2020 and January 2021. The primary objective was association of death and MRC-ICU score at 48 hours after ICU admission. Secondary objectives were association of MRC-ICU with duration of mechanical ventilation (MV), hospital LOS, and PaO2:FiO2 (P:F) ratio at 48 hours after ICU admission. The primary objective was assessed with binary logistic regression and all secondary outcomes with linear regression or descriptive statistics.
Results: A total of 151 patients were included with a median MRC-ICU score of 15 (IQR 7.75–21). The in-hospital mortality rate was 38.5%. When controlling for age and sex, every one point increase in MRC was associated with a 10% increase in death (OR 1.109, β 0.104, p< 0.01). MRC-ICU score was not associated with an increase in duration of MV, hospital LOS, or decrease in P:F ratio (all p >0.05).
Conclusions: While a higher MRC-ICU score at 48 hours predicted inpatient mortality, there was no association with duration of MV, hospital LOS, or worsening oxygenation. The MRC-ICU score may help clinicians identify the sickest patients with the highest risk of death and determine optimal utilization of pharmacist resources.