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Van Moorter N, Tackaert T, De Decker K, Van Vlem B, De Neve N. New potential for an old kid on the block: Impact of premorbid metformin use on lactate kinetics, kidney injury and mortality in sepsis and septic shock, an observational study. Endocrinol Diabetes Metab 2022; 6:e382. [PMID: 36444165 PMCID: PMC9836235 DOI: 10.1002/edm2.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Sepsis and septic shock cause significant mortality worldwide, with no targeted molecular therapies available. Metformin has pleomorphic effects that may be beneficial in sepsis, but at present, the impact of metformin exposure on sepsis remains controversial. Metformin might alter lactate metabolism, but little is known about its influence on lactate kinetics. We therefore investigated the impact of preadmission metformin use on lactate kinetics, acute kidney injury (AKI) and mortality in sepsis. MATERIALS AND METHODS We retrospectively analysed all ICU admissions with sepsis and septic shock between January 2013 and September 2020, identifying 77 users and 390 nonusers (subdivided in diabetics, n = 48 and nondiabetics, n = 342). RESULTS (Sub)groups did not differ in illness severity or sepsis aetiology. Admission lactate levels were similar, but evolution in lactate over the first 24 h showed a larger decrease in users vs nonusers (median - 53% vs. -36%, p = .010). No difference in AKI or renal replacement therapy was found. Mortality was lower in users vs nonusers in case of septic shock (21.9% (n = 7) vs. 42.7% (n = 61) for 90d mortality, p = .029, OR 0.38 [95% CI: 0.15-0.93]), but showed no significant differences in the combined sepsis and septic shock population. CONCLUSIONS In our data, preadmission metformin use is associated with a significantly larger decrease in lactate after admission with sepsis or septic shock and with reduced mortality in septic shock. This underscores the need for further studies investigating the interplay between metformin, lactate and sepsis, thereby exploring the potential use of metformin or its pathways in sepsis.
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Affiliation(s)
- Nina Van Moorter
- Department of Internal MedicineGhent University/Ghent University HospitalGhentBelgium
| | - Thomas Tackaert
- Department of Emergency MedicineGhent University/Ghent University HospitalGhentBelgium
| | - Koen De Decker
- Department of Anaesthesiology and Critical Care MedicineOLVZ AalstAalstBelgium
| | | | - Nikolaas De Neve
- Department of Anaesthesiology and Critical Care MedicineOLVZ AalstAalstBelgium
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Association of Metformin Use During Hospitalization and Mortality in Critically Ill Adults With Type 2 Diabetes Mellitus and Sepsis. Crit Care Med 2022; 50:935-944. [PMID: 35120041 DOI: 10.1097/ccm.0000000000005468] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Whether metformin exposure is associated with improved outcomes in patients with type 2 diabetes mellitus and sepsis. DESIGN Retrospective cohort study. SETTING Patients admitted to ICUs in 16 hospitals in Pennsylvania from October 2008 to December 2014. PATIENTS Adult critical ill patients with type 2 diabetes mellitus and sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We conducted a retrospective cohort study to compare 90-day mortality in diabetic patients with sepsis with and without exposure to metformin during hospitalization. Data were obtained from the electronic health record of a large healthcare system in Pennsylvania from October 2008 to December 2014, on patients admitted to the ICU at any of the 16 hospitals within the system. The primary outcome was mortality at 90 days. The absolute and adjusted odds ratio (OR) with 95% CI were calculated in a propensity score-matched cohort. Among 14,847 patients with type 2 diabetes mellitus and sepsis, 682 patients (4.6%) were exposed to metformin during hospitalization and 14,165 (95.4%) were not. Within a total of 2,691 patients subjected to propensity score-matching at a 1:4 ratio, exposure to metformin (n = 599) was associated with decreased 90-day mortality (71/599, 11.9% vs 475/2,092, 22.7%; OR, 0.46; 95% CI, 0.35-0.60), reduced severe acute kidney injury (50% vs 57%; OR, 0.75; 95% CI, 0.62-0.90), less Major Adverse Kidney Events at 1 year (OR, 0.27; 95% CI, 0.22-0.68), and increased renal recovery (95% vs 86%; OR, 6.43; 95% CI, 3.42-12.1). CONCLUSIONS Metformin exposure during hospitalization is associated with a decrease in 90-day mortality in patients with type 2 diabetes mellitus and sepsis.
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Metformin Protects Against Cardiac and Renal Damage in Diabetic Cardiac Arrest Patients. Resuscitation 2022; 174:42-46. [PMID: 35331801 PMCID: PMC9050929 DOI: 10.1016/j.resuscitation.2022.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Metformin is a first-line diabetic therapy that improves survival in a wide number of ischemic pathologies. We tested the association of metformin with markers of cardiac and renal injury in diabetic post-arrest patients. METHODS We performed a retrospective analysis of clinical outcomes in diabetic cardiac arrest patients with and without metformin therapy at a single academic medical center. We used generalized linear models to test the independent association of metformin, insulin, and other hypoglycemic agents with peak 24-hour serum creatinine and peak 24-hour serum troponin. RESULTS Metformin prescription at the time of SCA was independently associated with lower 24-hour peak serum troponin and lower 24-hour peak serum creatinine when compared to non-metformin patients. CONCLUSION Metformin pretreatment may offer cardiac and renal protection for diabetic patients during sudden cardiac arrest.
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Shen W, Qu Y, Jiang H, Wang H, Pan Y, Zhang Y, Wu X, Han Y, Zhang Y. Therapeutic effect and safety of curcumin in women with PCOS: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:1051111. [PMID: 36387924 PMCID: PMC9646792 DOI: 10.3389/fendo.2022.1051111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a multi-factorial heterogeneous syndrome that has both adverse reproductive and metabolic implications for affected women and its management is a challenging clinical problem. Curcumin, as a phenolic compound with potent anti-inflammatory and antioxidant properties exerting positive effects on the lipid profile and insulin resistance, appears to be a valuable treatment regimen for patients with PCOS. OBJECTIVE This study aimed to evaluate the efficacy and safety of curcumin in the treatment of PCOS. METHODS Chinese databases (Chinese National Knowledge Infrastructure, China Biology Medicine Databases, VIP database, Wanfang Database, and Chinese Clinical Trial Registry) and English databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus and Clinical trials) were thoroughly investigated through screening randomized controlled trials on curcumin in PCOS published from the date of inception to May 2022. Standardized data search and abstraction were conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. Quantitative and qualitative analyses were performed. Heterogeneity was assessed using I2 statistics. RESULTS A total of 447 patients from seven randomized controlled trials were included in the meta-analysis. Results showed that the ingestion of curcumin decreased body mass index (WMD -0.267, 95% CI -0.450 to -0.084, P = 0.004, I2 = 0.0%), fasting plasma glucose (WMD -3.618, 95% CI -5.165 to -2.071, P < 0.001, I2 = 20.4%), insulin (WMD -1.834, 95% CI -2.701 to -0.968, P < 0.001, I2 = 8.4%), homeostatic model assessment for insulin resistance (WMD -0.565, 95% CI -0.779 to -0.351, P < 0.001, I2 = 0.0%), total cholesterol (WMD -15.591, 95% CI -27.908 to -3.273, P = 0.013, I2 = 68.9%), C-reactive protein (WMD -0.785, 95% CI -1.553 to -0.017, P = 0.045, I2 = 23.9%), and increased the quantitative insulin sensitivity check index (WMD 0.011, 95% CI 0.005 to 0.017, P = 0.001, I2 = 39.6%). As for safety, the treatment group did not cause significant adverse reactions than that in the control group. CONCLUSION In light of presented findings, curcumin has beneficial effects on serum markers of inflammation, weight loss and glucose and lipid metabolism in patients with PCOS. The incidence of adverse reactions does not increase with the application of curcumin. However, a larger, more definitive study is needed to further investigate these results. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier CRD42022332394.
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Affiliation(s)
- Wenjuan Shen
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yangfan Qu
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Huan Jiang
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Hongwei Wang
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yujia Pan
- Department of Traditional Chinese Medicine, Cixi People’s Hospital Medical and Health Group, Cixi, China
| | - Yuehui Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaoke Wu
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yanhua Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yang Zhang
- Department of Internal Medicine, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
- *Correspondence: Yang Zhang,
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Yang Q, Zheng J, Chen W, Chen X, Wen D, Chen W, Xiong X, Zhang Z. Association Between Preadmission Metformin Use and Outcomes in Intensive Care Unit Patients With Sepsis and Type 2 Diabetes: A Cohort Study. Front Med (Lausanne) 2021; 8:640785. [PMID: 33855034 PMCID: PMC8039324 DOI: 10.3389/fmed.2021.640785] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Sepsis is a deadly disease worldwide. Effective treatment strategy of sepsis remains limited. There still was a controversial about association between preadmission metformin use and mortality in sepsis patients with diabetes. We aimed to assess sepsis-related mortality in patients with type 2 diabetes (T2DM) who were preadmission metformin and non-metformin users. Methods: The patients with sepsis and T2DM were included from Medical Information Mart for Intensive Care -III database. Outcome was 30-day mortality. We used multivariable Cox regression analyses to calculate adjusted hazard ratio (HR) with 95% CI. Results: We included 2,383 sepsis patients with T2DM (476 and 1,907 patients were preadmission metformin and non-metformin uses) between 2001 and 2012. The overall 30-day mortality was 20.1% (480/2,383); it was 21.9% (418/1,907), and 13.0% (62/476) for non-metformin and metformin users, respectively. After adjusted for potential confounders, we found that preadmission metformin use was associated with 39% lower of 30-day mortality (HR = 0.61, 95% CI: 0.46–0.81, p = 0.007). In sensitivity analyses, subgroups analyses, and propensity score matching, the results remain stable. Conclusions: Preadmission metformin use may be associated with reduced risk-adjusted mortality in patients with sepsis and T2DM. It is worthy to further investigate this association.
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Affiliation(s)
- Qilin Yang
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiezhao Zheng
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiyan Chen
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaohua Chen
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Deliang Wen
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weixiao Chen
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuming Xiong
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenhui Zhang
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Li Y, Zhao H, Guo Y, Duan Y, Guo Y, Ding X. Association of Preadmission Metformin Use and Prognosis in Patients With Sepsis and Diabetes Mellitus: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:811776. [PMID: 35002982 PMCID: PMC8735596 DOI: 10.3389/fendo.2021.811776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/03/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND AIM A growing body of evidence suggests that preadmission metformin use could decrease the mortality of septic patients with diabetes mellitus (DM); however, the findings remain controversial. Therefore, this meta-analysis was conducted on available studies to confirm the relationship between preadmission metformin use and mortality in patients with sepsis and DM. METHODS A comprehensive search of the PubMed, Embase, and Cochrane Library databases was performed for studies published before August 8, 2021. Observational studies assessing the correlation between metformin use and mortality in patients with sepsis and DM were considered eligible studies. We used the Newcastle-Ottawa Scale (NOS) to assess the outcome quality of each included article. Furthermore, the odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed using the inverse variance method with random effects modeling. RESULTS Eleven articles including 8195 patients were analyzed in this meta-analysis. All the included articles were scored as low risk of bias. Our results showed that preadmission metformin use had a lower mortality rate (OR, 0.74; 95% CIs, 0.62-0.88, P < 0.01) in patients with sepsis and DM. Surprisingly, there was no statistically significant difference in the levels of serum creatinine (weighted mean difference (WMD), 0.36; 95% CIs, -0.03-0.75; P = 0.84) and lactic acid (WMD, -0.16; 95% CIs, -0.49-0.18; P = 0.07) between preadmission metformin use and non-metformin use. CONCLUSIONS This study is the most comprehensive meta-analysis at present, which shows that preadmission metformin use may reduce mortality and not increase the levels of serum creatinine and lactic acid in adult patients with sepsis and DM. Therefore, these data suggest that the potential efficacy of metformin could be assessed in future clinical studies. SYSTEMATIC REVIEW REGISTRATION https://inplasy.com/?s=INPLASY2021100113, identifier INPLASY2021100113.
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Affiliation(s)
- Yuanzhe Li
- Department of Pediatrics, Children’s Hospital Affiliated of Zhengzhou University, Zhengzhou, China
| | - Huayan Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yalin Guo
- Department of Pediatrics, Children’s Hospital Affiliated of Zhengzhou University, Zhengzhou, China
| | - Yongtao Duan
- Department of Pediatrics, Children’s Hospital Affiliated of Zhengzhou University, Zhengzhou, China
| | - Yanjun Guo
- Department of Pediatrics, Children’s Hospital Affiliated of Zhengzhou University, Zhengzhou, China
- *Correspondence: Xianfei Ding, ; Yanjun Guo,
| | - Xianfei Ding
- General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Xianfei Ding, ; Yanjun Guo,
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Yang Q, Zheng J, Wen D, Chen X, Chen W, Chen W, Xiong X, Zhang Z. Association between metformin use on admission and outcomes in intensive care unit patients with acute kidney injury and type 2 diabetes: A retrospective cohort study. J Crit Care 2020; 62:206-211. [PMID: 33422811 DOI: 10.1016/j.jcrc.2020.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/06/2020] [Accepted: 12/12/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Acute kidney injury (AKI) occurs in more than half of intensive care unit patients. Effective prevention and treatment strategies for AKI remain limited. We aimed to assess AKI-related mortality in patients with diabetes who were metformin and non-metformin users. MATERIALS AND METHODS We included patients with AKI and type 2 diabetes (T2DM) from the Medical Information Mart for Intensive Care database. The 30-day mortality, neutrophil-to-lymphocyte ratio, and length of hospital stay were compared between patients with and without metformin prescriptions. We used multivariable Cox proportional hazards regression, propensity score analysis, and an inverse probability-weighting model to ensure the robustness of our findings. RESULTS We included 4328 patients with AKI and T2DM (998 and 3330 patients were metformin and non-metformin users, respectively). The overall 30-day mortality was 14.2% (613/4328); it was 15.7% (523/3330) and 9.0% (90/998) for non-metformin and metformin users, respectively. In the inverse probability-weighting model, metformin use was associated with 37% lower 30-day mortality (HR = 0.63, 95% CI: 0.50-0.80, p < 0.0001). CONCLUSIONS Metformin use may be associated with reduced risk-adjusted mortality in patients with AKI and T2DM. Further randomized controlled trials are needed to clarify this association.
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Affiliation(s)
- Qilin Yang
- Department of Critical Care, the Second Affiliated Hospital of Guangzhou Medical University, No. 250 Changgang East Road, Haizhu District, Guangzhou, Guangdong, China.
| | - Jiezhao Zheng
- Department of Critical Care, the Second Affiliated Hospital of Guangzhou Medical University, No. 250 Changgang East Road, Haizhu District, Guangzhou, Guangdong, China.
| | - Deliang Wen
- Department of Critical Care, the Second Affiliated Hospital of Guangzhou Medical University, No. 250 Changgang East Road, Haizhu District, Guangzhou, Guangdong, China.
| | - Xiaohua Chen
- Department of Critical Care, the Second Affiliated Hospital of Guangzhou Medical University, No. 250 Changgang East Road, Haizhu District, Guangzhou, Guangdong, China.
| | - Weiyan Chen
- Department of Critical Care, the Second Affiliated Hospital of Guangzhou Medical University, No. 250 Changgang East Road, Haizhu District, Guangzhou, Guangdong, China.
| | - Weixiao Chen
- Department of Critical Care, the Second Affiliated Hospital of Guangzhou Medical University, No. 250 Changgang East Road, Haizhu District, Guangzhou, Guangdong, China.
| | - Xuming Xiong
- Department of Critical Care, the Second Affiliated Hospital of Guangzhou Medical University, No. 250 Changgang East Road, Haizhu District, Guangzhou, Guangdong, China.
| | - Zhenhui Zhang
- Department of Critical Care, the Second Affiliated Hospital of Guangzhou Medical University, No. 250 Changgang East Road, Haizhu District, Guangzhou, Guangdong, China.
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Lin CS, Chang CC, Yeh CC, Chang YC, Chen TL, Liao CC. Outcomes after surgery in patients with diabetes who used metformin: a retrospective cohort study based on a real-world database. BMJ Open Diabetes Res Care 2020; 8:8/2/e001351. [PMID: 33257420 PMCID: PMC7705543 DOI: 10.1136/bmjdrc-2020-001351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Limited information was available regarding the perioperative outcomes in patients with and without use of metformin. This study aims to evaluate the complications and mortality after major surgery in patients with diabetes who use metformin. RESEARCH DESIGN AND METHODS Using a real-world database of Taiwan's National Health Insurance from 2008 to 2013, we conducted a matched cohort study of 91 356 patients with diabetes aged >20 years who used metformin and later underwent major surgery. Using a propensity score-matching technique adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 91 356 controls who underwent surgery but did not use metformin were selected. Logistic regression was used to calculate the ORs with 95% CIs for postoperative complications and 30-day mortality associated with metformin use. RESULTS Patients who used metformin had a lower risk of postoperative septicemia (OR 0.94, 95% CI 0.90 to 0.98), acute renal failure (OR 0.87, 95% CI 0.79 to 0.96), and 30-day mortality (OR 0.79, 95% CI 0.71 to 0.88) compared with patients who did not use metformin, in both sexes and in every age group. Metformin users who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR 0.60, 95% CI 0.59 to 0.62) and lower medical expenditures (p<0.0001) than non-use controls. CONCLUSIONS Among patients with diabetes, those who used metformin and underwent major surgery had a lower risk of complications and mortality compared with non-users. Further randomized clinical trials are needed to show direct evidence of how metformin improves perioperative outcomes.
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Affiliation(s)
- Chao-Shun Lin
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Chau Chang
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
| | - Yi-Cheng Chang
- Division of Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ta-Liang Chen
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Liang H, Ding X, Sun T. Response to "Association between metformin use prior to admission and lower mortality in septic adult patients with diabetes mellitus: beware of potential confounders". CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:196. [PMID: 32375826 PMCID: PMC7201954 DOI: 10.1186/s13054-020-02918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/24/2020] [Indexed: 12/05/2022]
Affiliation(s)
- Huoyan Liang
- General ICU, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xianfei Ding
- General ICU, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Tongwen Sun
- General ICU, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Posma RA, Frøslev T, Jespersen B, van der Horst ICC, Touw DJ, Thomsen RW, Nijsten MW, Christiansen CF. Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study. Ann Intensive Care 2020; 10:36. [PMID: 32219580 PMCID: PMC7098407 DOI: 10.1186/s13613-020-00652-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/16/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers. METHODS This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model. RESULTS Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2-3.2) in metformin users and 1.6 (1.0-2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users. CONCLUSION In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.
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Affiliation(s)
- Rene A Posma
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. .,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht University, Maastricht, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Maarten W Nijsten
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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The Association of Premorbid Metformin Exposure With Mortality and Organ Dysfunction in Sepsis: A Systematic Review and Meta-Analysis. Crit Care Explor 2020; 1:e0009. [PMID: 32166255 PMCID: PMC7063877 DOI: 10.1097/cce.0000000000000009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Supplemental Digital Content is available in the text. To examine the association between premorbid metformin exposure and mortality, hyperlactatemia, and organ dysfunction in sepsis.
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Association between prior metformin therapy and sepsis in diabetes patients: a nationwide sample cohort study. J Anesth 2020; 34:358-366. [PMID: 32146543 DOI: 10.1007/s00540-020-02753-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/22/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE There have been no large-scale studies on whether metformin therapy might have a potential benefit for lowering mortality. Thus, this study aimed to investigate the association between prior metformin therapy and the development of sepsis as well as the association between prior metformin therapy and 30-day mortality in sepsis patients. METHODS We evaluated adult diabetes patients registered in the 2010 sample cohort database of the National Health Insurance Service in South Korea. Diabetes was identified according to the International Classification of Disease-10 diagnostic system (E10-E14). The cohorts were divided into the metformin user group (i.e., those who had been prescribed continuous oral metformin over a period of ≥ 90 days) and the control group (i.e., all other individuals). The primary endpoint was the development of sepsis between 2011 and 2015, and the secondary endpoint was 30-day mortality among diabetes patients diagnosed with sepsis. RESULTS In total, 77,337 patients (34,041 in the metformin user group and 43,296 in the control group) were included in the analysis, among whom 2512 patients (3.2%) were diagnosed with sepsis between 2011 and 2015. After propensity score adjustment, metformin use was not significantly associated with both the risk of sepsis (OR: 0.92, 95%CI 0.82-1.03; P = 0.143) and the risk of 30-day mortality after diagnosis of sepsis (OR: 0.94, 95%CI 0.75-1.17; P = 0.571). CONCLUSIONS Prior metformin therapy was not significantly associated with the risk of sepsis and 30-day mortality after diagnosis of sepsis among diabetes patients.
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Simon M, Baudry T, Hernu R, Cour M, Argaud L. Intoxication à la metformine. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La metformine, seul représentant disponible en France de la classe des biguanides, est un médicament antidiabétique largement prescrit. L’effet thérapeutique bénéfique du contrôle glycémique obtenu par inhibition de la néoglucogenèse est objectivé par une réduction de la morbimortalité chez les patients diabétiques de type 2. Néanmoins, la metformine affecte aussi le métabolisme du lactate en augmentant sa production par la cellule. Ainsi, l’effet secondaire le plus redouté est l’acidose lactique associée à la metformine (metformin-associated lactic acidosis [MALA]). Celle-ci est liée à une augmentation brutale de la concentration en metformine dans le sang et dans les tissus, que ce soit après ingestion d’une grande quantité de médicament ou plus souvent dans les suites d’une insuffisance rénale aiguë chez un patient traité au long cours. Dans ce contexte d’acidose métabolique majeure avec hyperlactatémie, la sévérité des défaillances d’organes conditionne le pronostic. La prise en charge thérapeutique est symptomatique avec recours précoce à une épuration extrarénale dans les formes sévères ou ne répondant pas au traitement initial. La prévention de la MALA repose avant tout sur le respect des contreindications de la metformine chez les patients diabétiques.
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Liang H, Ding X, Li L, Wang T, Kan Q, Wang L, Sun T. Association of preadmission metformin use and mortality in patients with sepsis and diabetes mellitus: a systematic review and meta-analysis of cohort studies. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:50. [PMID: 30777119 PMCID: PMC6379943 DOI: 10.1186/s13054-019-2346-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/06/2019] [Indexed: 12/12/2022]
Abstract
Background Recent studies have reported that preadmission metformin users had lower mortality than non-metformin users in patients with sepsis and diabetes mellitus; however, these results are still controversial. Therefore, we conducted a systematic review and meta-analysis of published observational cohort data to determine the association between preadmission metformin use and mortality in septic adult patients with diabetes mellitus. Methods The MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched from their inception to September 30, 2018. Cohort studies that evaluated the use of metformin in septic adult patients with diabetes mellitus were included. The quality of outcomes was evaluated using the Newcastle-Ottawa Scale (NOS). The inverse variance method with random effects modelling was used to calculate the pooled odds ratios (ORs) and 95% CIs. Results Five observational cohort studies (1282 patients) that were all judged as having a low risk of bias were included. In this meta-analysis, metformin use was associated with a significantly lower mortality rate (OR, 0.59; 95% CI, 0.43–0.79, P = 0.001). Conclusions This meta-analysis indicated an association between metformin use prior to admission and lower mortality in septic adult patients with diabetes mellitus. This finding suggested that the possible effect of metformin should be evaluated in future clinical trials.
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Affiliation(s)
- Huoyan Liang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, 450052, China
| | - Xianfei Ding
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, 450052, China
| | - Lifeng Li
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Tian Wang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Quancheng Kan
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Lexin Wang
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia
| | - Tongwen Sun
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, 450052, China.
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