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. 2022 Jun 1;50(6):935-944.
doi: 10.1097/CCM.0000000000005468. Epub 2022 Feb 7.

Association of Metformin Use During Hospitalization and Mortality in Critically Ill Adults With Type 2 Diabetes Mellitus and Sepsis

Hernando Gómez  1   2 , Gaspar Del Rio-Pertuz  2   3 , Priyanka Priyanka  1   2 , Carlos L Manrique-Caballero  1   2 , Chung-Chou H Chang  2   4 , Shu Wang  5 , Qing Liu  6 , Brian S Zuckerbraun  2   7 , Raghavan Murugan  1   2 , Derek C Angus  1   2 , John A Kellum  1   2
Affiliations

Association of Metformin Use During Hospitalization and Mortality in Critically Ill Adults With Type 2 Diabetes Mellitus and Sepsis

Hernando Gómez et al. Crit Care Med. .

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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Conflict of interest statement

Dr. Gomez reports support as principal investigator of the Limiting Acute Kidney Injury Progression in Sepsis (LAPIS) trial from Biomerieux. Drs. Gomez and Murugan report personal fees from AM-Pharma for enrolling patients in clinical trial of recombinant alkaline phosphatase in sepsis-associated acute kidney injury. Drs. Gomez’s, Zuckerbraun’s, and Angus’s institutions received funding from the National Institute of General Medical Sciences. Drs. Gomez, Zuckerbraun, Murugan, and Angus received support for article research from the National Institutes of Health (NIH). Dr. Priyanka disclosed work for hire. Dr. Zuckerbraun’s institution received funding from the Veteran’s Affairs; he disclosed government work. Dr. Murugan’s institution received funding from AM Pharma and Baxter; he received funding from the National Institute of Diabetes and Digestive and Kidney Diseases; and he disclosed the off-label product use of metformin of sepsis-associated acute kidney injury. Dr. Angus’ institution received funding from the NIH (R01 NR018434) and (R01 HS025146). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

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