ISSN: 2574-8009
Authors: Sharma R, Nagaich N* and Niranjana N
Objectives: To determine the association between clinico- pharmacologic score (CPS) and clinical outcomes in patients admitted in critical care (≥45 y), focusing on outcome prognostication. Methods: A retrospective study of patient’s of ages ≥ 45 years was performed using a Hospital database. The study period was from 1st August 2017 to 31st August 2018. Data gathered included patient demographics, injury severity score (ISS), Glasgow coma scale (GCS), hospital and intensive care unit lengths of stay (HLOS and ILOS, respectively), home preinjury medications (prescription and over the counter), morbidity, comorbid conditions and in-hospital mortality. Then according to CPS ranges, patients were divided into four groups and then to two groups (for statistical purposes). Results: The variables for the 205 patients included in the study, were analyzed. The mean patient age was 72.4 ± 13.1 years. Males represented 52 % of the study sample. Mean GCS was 13.2 ± 1.8, mean ISS was 9.4 ± 6.9 and mean number of medications per patient was 3.6±1.5 (range 0-16). The independent predictors of mortality included age (AOR 1.21, 95 % CI 0.98-1.038, p<0.01), CPS (per-unit increase AOR 1.12, 95 % CI 1.01-1.24, p<0.02), GCS (per-unit decrease AOR 1.47, 95 % CI 1.13-1.69, p<0.01), and ISS (per-unit increase AOR 1.07, 95 % CI 1.03-1.13, p<0.01). Independent predictors of all-cause morbidity included age (AOR 1.02, 95 % CI 1.01-1.03, p<0.01), CPS (per-unit AOR 1.04, 95 % CI 1.02-1.07, p<0.02), GCS (AOR 1.08 per-unit decrease, 95 % CI 1.03-1.11, p<0.01), and ISS (per-unit AOR 1.09, 95 % CI 1.08-1.11, p<0.01). Independent predictors of discharge to a facility included age (AOR 1.02, 95 % CI 1.01-1.03, p<0.01), female gender (AOR 1.25, 95 % CI 1.10-1.43, p<0.01), ISS (AOR 1.09, 95 % CI 1.07-1.10, p<0.01), and GCS (AOR per-unit decline 1.18, 95 % CI 1.12-1.21, p\0.01). Conclusion: CPS can be readily determined in the era of medication reconciliation. This study confirms that CPS is an independent predictor of all-cause morbidity and mortality in older patients. Patients with CPS of 15 or greater are at greater risk of poor clinical outcomes. Prospective multicenter studies are needed to evaluate the use of CPS as a predictive and interventional tool, with special focus on correlations between specific pre-existing conditions, pharmacologic interactions, and morbidity/mortality patterns.
Keywords: Polypharmacy; Injury Severity; Clinico Pharmacologic Score
