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Low Hemoglobin A1c Linked to Poor Prognosis

Hemoglobin A1c (HbA1c) is associated with poorer prognosis in patients with advanced liver disease. Approximately 40% of patients with cirrhosis and 20% of patients with hepatic fibrosis have HbA1c levels below 4.5%. Several studies have demonstrated that a HbA1c level below 5% is associated with increased risk of all-cause mortality. A J-shaped association exists between HbA1c and abnormal liver enzymes, hepatic steatosis, hospitalization due to liver disease and all-cause mortality, with the nadir of the curve at 4.7 to 5.5%. HbA1c levels above and below this range are both associated with increased health risks.

Low HbA1c levels in advanced liver disease may be caused by impaired glucose and insulin metabolism, depressed erythropoiesis, decreased protein synthesis, and/or shortened RBC survival. Extremely low HbA1c have clinical significance and should be investigated.

Ping Wang, Lab Med. 2017;48(1):89-92 

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