Liu Yanhua, Zhang Jianna, Chun Xueli, Gao Yongli, Yao Rong, Liang Yin, Zhu Ling, He Ying, Huang Wenxia
Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing/Disaster Medicine Center, Sichuan University, Chengdu, China; Institute of Disaster Medicine, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China.
Center of Gerontology and Geriatrics, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
Endocr Pract. 2024 Sep;30(9):795-801. doi: 10.1016/j.eprac.2024.06.004. Epub 2024 Jun 13.
Continuous glucose monitoring (CGM) may have benefits in achieving glycemic control in critically ill patients. The aim of this study was to assess the accuracy of the Freestyle Libre H (professional version similar to the Libre Pro) in patients with acute respiratory failure (ARF) in the intensive care unit (ICU).
Fifty-two adult patients with ARF were selected. The performance of CGM was evaluated using the arterial blood glucose (aBG) and point-of-care (POC) glucose levels as the reference values. Numerical accuracy was evaluated by the mean absolute relative difference, Bland-Altman analysis, %15/15 (the percentage of CGM values within 15 mg/dL or 15% of reference values <100 or >100 mg/dL, respectively), %20/20, and %30/30. Clinical accuracy was assessed using the Clarke error grid analysis.
A total of 519 and 1504 pairs of aBG/CGM and POC/CGM glucose values were analyzed. The mean absolute relative difference values were 13.8% and 14.7%, respectively. The mean deviations of the Bland-Altman analysis were 0.82 mmol/L and 0.81 mmol/L. The proportions of CGM values within %15/15, %20/20, and %30/30 of the aBG values were 62.6%, 75.5%, and 92.4%, respectively; those within %15/15, %20/20, and %30/30 of the POC values were 57.1%, 72.9%, and 88.7%, respectively. The Clarke error grid analysis showed that 97.8% and 99.3% of the values were located in zone A + B. Additionally, the accuracy of CGM was not affected by general patient factors.
This study demonstrated that the accuracy of CGM in patients with ARF is lower than that in most outpatients and it is not affected by general patient factors. Whether CGM is beneficial to glucose management in the intensive care unit needs further evaluation.
持续葡萄糖监测（CGM）可能有助于重症患者实现血糖控制。本研究旨在评估Freestyle Libre H（类似于Libre Pro的专业版）在重症监护病房（ICU）急性呼吸衰竭（ARF）患者中的准确性。
选取52例成年ARF患者。以动脉血糖（aBG）和即时检测（POC）血糖水平作为参考值，评估CGM的性能。通过平均绝对相对差值、Bland-Altman分析、%15/15（CGM值分别在参考值<100或>100mg/dL的15mg/dL或15%范围内的百分比）、%20/20和%30/30评估数值准确性。使用克拉克误差网格分析评估临床准确性。
共分析了519对和1504对aBG/CGM及POC/CGM血糖值。平均绝对相对差值分别为13.8%和14.7%。Bland-Altman分析的平均偏差分别为0.82mmol/L和0.81mmol/L。CGM值在aBG值的%15/15、%20/20和%30/30范围内的比例分别为62.6%、75.5%和92.4%；在POC值的%15/15、%20/20和%30/30范围内的比例分别为57.1%、72.9%和88.7%。克拉克误差网格分析显示，97.8%和99.3%的值位于A+B区。此外，CGM的准确性不受一般患者因素影响。
本研究表明，ARF患者中CGM的准确性低于大多数门诊患者，且不受一般患者因素影响。CGM对ICU血糖管理是否有益需要进一步评估。
