Direct and indirect associations of stress hyperglycemia with delirium in older adults with community-acquired pneumonia: limited mediation by neutrophil-lymphocyte ratio and procalcitonin

In older CAP patients, stress hyperglycaemia substantially elevates delirium risk, predominantly through a direct mechanism only partly (≈ 20%) mediated by systemic inflammation reflected by NLR. Prompt detection and management of acute hyperglycaemia may therefore offer a practical approach to delirium prevention. Prospective multicentre studies are needed to confirm causality and to test glucose- and inflammation-modulating interventions.