Olney William J, Chase Aaron M, Hannah Sarah A, Smith Susan E, Newsome Andrea Sikora
Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY, USA.
Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, USA.
J Pharm Pract. 2022 Aug;35(4):573-579. doi: 10.1177/0897190021999792. Epub 2021 Mar 9.
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.
To evaluate the relationship between MRC-ICU score and fluid overload in critically ill patients.
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.
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.
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.
重症患者发生液体超负荷的风险增加，但缺乏指导临床决策的客观预测工具。MRC-ICU评分工具是一种用于衡量用药方案复杂性的客观工具。
评估MRC-ICU评分与重症患者液体超负荷之间的关系。
在这项多中心、回顾性、观察性研究中，考察了MRC-ICU与液体超负荷风险之间的关系。从病历中收集患者人口统计学资料、入住重症监护病房第3天的液体平衡情况、24小时时的MRC-ICU评分以及临床结局。主要结局是MRC-ICU与液体超负荷之间的关系。为分析此关系，将MRC-ICU评分分为三分位数（低、中、高），并进行二元逻辑回归。进行线性回归以确定与液体正平衡相关的变量。
共纳入125例患者。入住重症监护病房24小时时，低、中、高三分位数的MRC-ICU评分中位数分别为9、15和21。MRC-ICU每增加1分，液体超负荷的可能性增加13%（比值比1.128，95%置信区间1.028 - 1.238，p = 0.011）。在控制年龄、性别和序贯器官衰竭评估（SOFA）评分时，MRC-ICU评分与第3天的液体平衡呈正相关（β系数218.455，95%置信区间94.693 - 342.217，p = 0.001）。
用药方案复杂性与重症患者的液体超负荷呈弱正相关。未来有必要开展研究，将MRC-ICU确立为识别有液体超负荷风险患者的预测指标。
