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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Association of Admission Medication Regimen Complexity with Delirium in Critically Ill Adults: A Prospective Multicenter Cohort Study

  • Abrar Alotaibi1,2
  • Maram Alshreef3
  • Qoot Almedainy3
  • Alaa Almagthali2
  • Ahmed Basilim4
  • Ahmad Majrashi5
  • Abdulhamid Althagafi4
  • Eman Alqahtani3
  • Qasem Bahri5
  • Dina Kutbi6
  • Arwa Albeladi7
7 affiliations
  1. 1Department of Clinical Pharmacy, Al Hada Armed Forces Hospital, Taif 26792, Saudi Arabia
  2. 2Department of Clinical Pharmacy, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
  3. 3Department of Pharmaceutical Services, Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia
  4. 4Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah 22254, Saudi Arabia
  5. 5Department of Clinical Pharmacy, King Fahad Central Hospital, Jazan 82666, Saudi Arabia
  6. 6Department of Pharmacy, King Fahad Armed Forces Hospital, Jeddah 23311, Saudi Arabia
  7. 7College of Pharmacy, Batterjee Medical College, Jeddah 21442, Saudi Arabia
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Abstract

Background: The medication regimen complexity–intensive care unit (MRC-ICU) score is a validated tool for assessing medication regimen complexity in critically ill patients and has been associated with several clinical outcomes. However, its association with delirium remains poorly characterized. This study aimed to evaluate the association between the day-1 MRC-ICU score and delirium development and to describe associated clinical outcomes. Methods: This prospective multicenter cohort study enrolled 364 adult patients admitted to intensive care units (ICUs) across four tertiary hospitals between January and April 2025. MRC-ICU, sequential organ failure assessment, and acute physiology and chronic health evaluation II (APACHE II) scores were recorded within 24 h of admission. The primary outcome was delirium during the ICU stay. Secondary outcomes were acute kidney injury (AKI), fluid overload (FO), renal replacement therapy (RRT), ICU and hospital mortality, and ICU and hospital length of stay. Logistic regression was used to assess the association between day-1 MRC-ICU score and delirium. Results: Delirium occurred in 12 patients (3.3%). Baseline MRC-ICU scores did not significantly differ between the delirium and no-delirium groups (median, 12 vs. 11; p = 0.364). No statistically significant association was detected per 5-point increase in the day-1 MRC-ICU score in either the unadjusted model (odds ratio [OR] 1.28, 95% confidence interval [CI] 0.73–2.23; p = 0.385) or the APACHE II-adjusted model (OR 1.27, 95% CI 0.73–2.22; p = 0.398). Patients who developed delirium had higher rates of incident AKI (33.3% vs. 4.5%; p = 0.009), FO (83.3% vs. 10.5%), RRT initiation (66.7% vs. 4.3%), ICU mortality (83.3% vs. 12.5%), and hospital mortality (100% vs. 17.0%) (p < 0.001 for the remaining outcomes). Conclusions: No statistically significant association was detected between the day-1 MRC-ICU score and delirium development. Delirium was associated with higher rates of adverse clinical outcomes. However, the small number of delirium events and imprecise estimates preclude definitive conclusions regarding the association between admission medication regimen complexity and delirium risk.

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Cite

BibTeXRIS
BibTeX
@article{alotaibi2026association,
  title = {{Association of Admission Medication Regimen Complexity with Delirium in Critically Ill Adults: A Prospective Multicenter Cohort Study}},
  author = {Abrar Alotaibi and Maram Alshreef and Qoot Almedainy and Alaa Almagthali and Ahmed Basilim and Ahmad Majrashi and Abdulhamid Althagafi and Eman Alqahtani and Qasem Bahri and Dina Kutbi and Arwa Albeladi},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218457},
  url = {https://www.mdpi.com/2077-0383/15/21/8457},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Association of Admission Medication Regimen Complexity with Delirium in Critically Ill Adults: A Prospective Multicenter Cohort Study
AU  - Abrar Alotaibi
AU  - Maram Alshreef
AU  - Qoot Almedainy
AU  - Alaa Almagthali
AU  - Ahmed Basilim
AU  - Ahmad Majrashi
AU  - Abdulhamid Althagafi
AU  - Eman Alqahtani
AU  - Qasem Bahri
AU  - Dina Kutbi
AU  - Arwa Albeladi
PY  - 2026
DA  - 2026/10/30
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218457
UR  - https://www.mdpi.com/2077-0383/15/21/8457
AB  - Background: The medication regimen complexity–intensive care unit (MRC-ICU) score is a validated tool for assessing medication regimen complexity in critically ill patients and has been associated with several clinical outcomes. However, its association with delirium remains poorly characterized. This study aimed to evaluate the association between the day-1 MRC-ICU score and delirium development and to describe associated clinical outcomes. Methods: This prospective multicenter cohort study enrolled 364 adult patients admitted to intensive care units (ICUs) across four tertiary hospitals between January and April 2025. MRC-ICU, sequential organ failure assessment, and acute physiology and chronic health evaluation II (APACHE II) scores were recorded within 24 h of admission. The primary outcome was delirium during the ICU stay. Secondary outcomes were acute kidney injury (AKI), fluid overload (FO), renal replacement therapy (RRT), ICU and hospital mortality, and ICU and hospital length of stay. Logistic regression was used to assess the association between day-1 MRC-ICU score and delirium. Results: Delirium occurred in 12 patients (3.3%). Baseline MRC-ICU scores did not significantly differ between the delirium and no-delirium groups (median, 12 vs. 11; p = 0.364). No statistically significant association was detected per 5-point increase in the day-1 MRC-ICU score in either the unadjusted model (odds ratio [OR] 1.28, 95% confidence interval [CI] 0.73–2.23; p = 0.385) or the APACHE II-adjusted model (OR 1.27, 95% CI 0.73–2.22; p = 0.398). Patients who developed delirium had higher rates of incident AKI (33.3% vs. 4.5%; p = 0.009), FO (83.3% vs. 10.5%), RRT initiation (66.7% vs. 4.3%), ICU mortality (83.3% vs. 12.5%), and hospital mortality (100% vs. 17.0%) (p < 0.001 for the remaining outcomes). Conclusions: No statistically significant association was detected between the day-1 MRC-ICU score and delirium development. Delirium was associated with higher rates of adverse clinical outcomes. However, the small number of delirium events and imprecise estimates preclude definitive conclusions regarding the association between admission medication regimen complexity and delirium risk.
SN  - 2077-0383
ER  -