Luethi Nora, Cioccari Luca, Tanaka Aiko, Kar Palash, Giersch Emma, Deane Adam M, Mårtensson Johan, Bellomo Rinaldo
1Department of Intensive Care, Austin Hospital, The University of Melbourne, Melbourne, VIC, Australia.2Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.3Discipline of Acute Care Medicine, Department of Intensive Care, University of Adelaide, Adelaide, SA, Australia.4Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.5Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Crit Care Med. 2016 Sep;44(9):1692-4. doi: 10.1097/CCM.0000000000001656.
Glycated hemoglobin A1c is used to estimate glycemic control. However, its value upon ICU admission may be altered by critical illness and not reflect true glycemic status. We assessed the relationship between ICU admission glycated hemoglobin A1c and premorbid glycated hemoglobin A1c levels.
Retrospective observational cohort study.
Two tertiary ICUs in Australia.
Cohort of 69 critically ill patients with diabetes and glycated hemoglobin A1c levels measured upon ICU admission and during the month prior to admission.
Measurement of glycated hemoglobin A1c.
Mean (SD) glycated hemoglobin A1c level was 7.5% (1.8%) upon ICU admission and 7.8% (2.0%) in previous measurements from the preceding 30 days. The change in glycated hemoglobin A1c did not correlate with time elapsed between the two measurements (r = 0.00005; p = 0.95), but there was a strong correlation between admission glycated hemoglobin A1c levels and premorbid glycated hemoglobin A1c levels (r = 0.89; p < 0.001).
Glycated hemoglobin A1c levels are not altered by the onset of critical illness. Glycated hemoglobin A1c quantified at ICU admission can, therefore, be used to reliably estimate chronic glycemic control and guide acute glycemic therapy.
糖化血红蛋白A1c用于评估血糖控制情况。然而，其在入住重症监护病房（ICU）时的值可能会因危重病而改变，无法反映真实的血糖状态。我们评估了入住ICU时的糖化血红蛋白A1c与病前糖化血红蛋白A1c水平之间的关系。
回顾性观察队列研究。
澳大利亚的两个三级ICU。
69例患有糖尿病的危重症患者队列，在入住ICU时及入院前一个月测量糖化血红蛋白A1c水平。
测量糖化血红蛋白A1c。
入住ICU时糖化血红蛋白A1c的平均（标准差）水平为7.5%（1.8%），前30天之前的测量值为7.8%（2.0%）。糖化血红蛋白A1c的变化与两次测量之间的时间间隔无关（r = 0.00005；p = 0.95），但入住时糖化血红蛋白A1c水平与病前糖化血红蛋白A1c水平之间存在强相关性（r = 0.89；p < 0.001）。
危重病的发作不会改变糖化血红蛋白A1c水平。因此，在入住ICU时定量的糖化血红蛋白A1c可用于可靠地评估慢性血糖控制情况并指导急性血糖治疗。
