title: Leveraging a critical care database: selective serotonin reuptake inhibitor use prior to ICU admission is associated with increased hospital mortality.
abstract: BACKGROUND
  Observational studies have found an increased risk of adverse effects such as hemorrhage, stroke, and increased mortality in patients taking selective serotonin reuptake inhibitors (SSRIs). The impact of prior use of these medications on outcomes in critically ill patients has not been previously examined. We performed a retrospective study to determine if preadmission use of SSRIs or serotonin norepinephrine reuptake inhibitors (SNRIs) is associated with mortality differences in patients admitted to the ICU.
  
  
  METHODS
  The retrospective study used a modifiable data mining technique applied to the publicly available Multiparameter Intelligent Monitoring in Intensive Care (MIMIC) 2.6 database. A total of 14,709 patient records, consisting of 2,471 in the SSRI/SNRI group and 12,238 control subjects, were analyzed. The study outcome was in-hospital mortality.
  
  
  RESULTS
  After adjustment for age, Simplified Acute Physiology Score, vasopressor use, ventilator use, and combined Elixhauser score, SSRI/SNRI use was associated with significantly increased in-hospital mortality (OR, 1.19; 95% CI, 1.02-1.40; P=.026). Among patient subgroups, risk was highest in patients with acute coronary syndrome (OR, 1.95; 95% CI, 1.21-3.13; P=.006) and patients admitted to the cardiac surgery recovery unit (OR, 1.51; 95% CI, 1.11-2.04; P=.008). Mortality appeared to vary by specific SSRI, with higher mortalities associated with higher levels of serotonin inhibition.
  
  
  CONCLUSIONS
  We found significant increases in hospital stay mortality among those patients in the ICU taking SSRI/SNRIs prior to admission as compared with control subjects. Mortality was higher in patients receiving SSRI/SNRI agents that produce greater degrees of serotonin reuptake inhibition. The study serves to demonstrate the potential for the future application of advanced data examination techniques upon detailed (and growing) clinical databases being made available by the digitization of medicine.
authors.affiliation: Massachusetts Institute of Technology, Cambridge, MA.
authors.forename: Marzyeh
authors.initials: M
authors.lastname: Ghassemi
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: John
authors.initials: J
authors.lastname: Marshall
authors.affiliation: Harvard School of Public Health, Boston, MA.
authors.forename: Nakul
authors.initials: N
authors.lastname: Singh
authors.affiliation: University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Stone
authors.affiliation: Massachusetts Institute of Technology, Cambridge, MA; Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: lceli@bidmc.harvard.edu.
authors.forename: Leo Anthony
authors.initials: LA
authors.lastname: Celi
mesh_terms: D000368:Aged; D003422:Critical Care; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000037:antagonists & inhibitors*; D010343:Patient Admission; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
chemical_list: D009638:Norepinephrine; D017367:Selective Serotonin Reuptake Inhibitors