The Association Between Frequency of Fingertip Blood Glucose Measurement and Delirium in Intensive Care Unit Patients: A Retrospective Study Based on the MIMIC-IV Database.

BACKGROUND

Tight blood glucose monitoring is crucial in the management of intensive care unit (ICU) delirium because glycaemic disorders were suggested as initiating risk factors. However, the association between the frequency of fingertip blood glucose measurement (FFBGM) owing to tight blood glucose monitoring and delirium in ICU patients remains unclear.

AIM

This study aimed to investigate the association between FFBGM and the risk of delirium among ICU patients.

STUDY DESIGN

This retrospective cohort study included 28 553 adult ICU patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Delirium was identified using the Confusion Assessment Method for the ICU tool. Multivariable logistic regression, restricted cubic spline regression, sensitivity analyses and subgroup analyses were used to evaluate the association between FFBGM frequency and ICU delirium.

RESULTS

Of the 28 553 participants, 9599 (33.60%) developed delirium. The participants were categorised into three cohorts based on tertile-derived thresholds for Total, Daytime and Nighttime FFBGM. Logistic regression analysis revealed a direct link between FFBGM and an increased incidence of critical delirium in ICU patients for each of the three variables (Total FFBGM Q3 vs. Q1: odds ratio [OR] = 1.25, 95% confidence interval [CI]: 1.18-1.32; Daytime FFBGM Q3 vs. Q1: OR = 1.21, 95% CI: 1.14-1.29; Nighttime FFBGM Q3 vs. Q1: OR = 1.17, 95% CI: 1.11-1.24). Sensitivity analysis, excluding diabetic and sedated patients, confirmed the robustness of the results. Furthermore, subgroup analysis showed consistent associations across demographic and clinical subgroups.

CONCLUSIONS

Increased FFBGM was independently associated with an increased risk of delirium among ICU patients. This finding suggests that FFBGM could serve as an independent predictor for delirium risk assessment.

RELEVANCE TO CLINICAL PRACTICE

This study may enhance nurses' awareness of the potential impact of FFBGM on delirium risk. It supports collaborative decision-making between nurses and physicians to balance glycaemic control with patient comfort and to optimise monitoring strategies in ICU care.