Does metformin exposure before ICU stay have any impact on patients’ outcome? A retrospective cohort study of diabetic patients
Abstract Background Impact of metformin exposure before ICU stay remains controversial. Metformin is thought to induce lactic acidosis and haemodynamic instability but may reduce ICU mortality. We evaluated its influence on outcome in diabetic patients admitted in the ICU and then compared two diffe...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2017-12-01
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| Series: | Annals of Intensive Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13613-017-0336-8 |
| _version_ | 1828486727802552320 |
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| author | Sebastien Jochmans Jean-Emmanuel Alphonsine Jonathan Chelly Ly Van Phach Vong Oumar Sy Nathalie Rolin Olivier Ellrodt Mehran Monchi Christophe Vinsonneau |
| author_facet | Sebastien Jochmans Jean-Emmanuel Alphonsine Jonathan Chelly Ly Van Phach Vong Oumar Sy Nathalie Rolin Olivier Ellrodt Mehran Monchi Christophe Vinsonneau |
| author_sort | Sebastien Jochmans |
| collection | DOAJ |
| description | Abstract Background Impact of metformin exposure before ICU stay remains controversial. Metformin is thought to induce lactic acidosis and haemodynamic instability but may reduce ICU mortality. We evaluated its influence on outcome in diabetic patients admitted in the ICU and then compared two different populations based on the presence of septic shock. Methods We conducted a retrospective cohort study in a 24-bed French ICU between October 2010 and December 2013, including all ICU-admitted diabetic patients. Results Among 635 diabetic patients admitted during the study period, 131 (21%) were admitted with septic shock. Multivariate analysis showed no difference in hospital mortality in all metformin users (OR 0.75 [95% CI 0.44–1.28]; p = 0.29), except in the septic shock subgroup (OR 0.61; 95% CI [0.37–0.99]; p = 0.04) despite higher vasopressor dosages in the first hours after shock onset. Blood lactate level was higher in metformin users than in non-metformin users in all patients (p < 0.001), in septic shock patients (p < 0.001) and in patients without kidney injury (p < 0.001). Metformin users did not have more septic shock from unknown aetiology (p = 0.65) or unknown pathogen (p = 0.99). Conclusions Metformin use before admission to ICU did not affect in-hospital mortality. However, for patients with septic shock, mortality was lower, despite worse clinical presentation on admission. Blood lactate levels were always higher with or without septic shock and indifferent of kidney function. |
| first_indexed | 2024-12-11T09:37:26Z |
| format | Article |
| id | doaj.art-86159033dc5e42e5835f76388d3a60c2 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-11T09:37:26Z |
| publishDate | 2017-12-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-86159033dc5e42e5835f76388d3a60c22022-12-22T01:12:47ZengSpringerOpenAnnals of Intensive Care2110-58202017-12-01711910.1186/s13613-017-0336-8Does metformin exposure before ICU stay have any impact on patients’ outcome? A retrospective cohort study of diabetic patientsSebastien Jochmans0Jean-Emmanuel Alphonsine1Jonathan Chelly2Ly Van Phach Vong3Oumar Sy4Nathalie Rolin5Olivier Ellrodt6Mehran Monchi7Christophe Vinsonneau8Département de Médecine Intensive et Unité de Recherche Clinique, Groupe Hospitalier Sud Ile-de-France, Hôpital de MelunService de Réanimation Médicale, AP-HP, Hôpital BicêtreDépartement de Médecine Intensive et Unité de Recherche Clinique, Groupe Hospitalier Sud Ile-de-France, Hôpital de MelunDépartement de Médecine Intensive, Groupe Hospitalier Sud Ile-de-France, Hôpital de MelunDépartement de Médecine Intensive, Groupe Hospitalier Sud Ile-de-France, Hôpital de MelunDépartement de Médecine Intensive, Groupe Hospitalier Sud Ile-de-France, Hôpital de MelunDépartement de Médecine Intensive, Groupe Hospitalier Sud Ile-de-France, Hôpital de MelunDépartement de Médecine Intensive et Unité de Recherche Clinique, Groupe Hospitalier Sud Ile-de-France, Hôpital de MelunService de Réanimation Polyvalente, Hôpital de BethuneAbstract Background Impact of metformin exposure before ICU stay remains controversial. Metformin is thought to induce lactic acidosis and haemodynamic instability but may reduce ICU mortality. We evaluated its influence on outcome in diabetic patients admitted in the ICU and then compared two different populations based on the presence of septic shock. Methods We conducted a retrospective cohort study in a 24-bed French ICU between October 2010 and December 2013, including all ICU-admitted diabetic patients. Results Among 635 diabetic patients admitted during the study period, 131 (21%) were admitted with septic shock. Multivariate analysis showed no difference in hospital mortality in all metformin users (OR 0.75 [95% CI 0.44–1.28]; p = 0.29), except in the septic shock subgroup (OR 0.61; 95% CI [0.37–0.99]; p = 0.04) despite higher vasopressor dosages in the first hours after shock onset. Blood lactate level was higher in metformin users than in non-metformin users in all patients (p < 0.001), in septic shock patients (p < 0.001) and in patients without kidney injury (p < 0.001). Metformin users did not have more septic shock from unknown aetiology (p = 0.65) or unknown pathogen (p = 0.99). Conclusions Metformin use before admission to ICU did not affect in-hospital mortality. However, for patients with septic shock, mortality was lower, despite worse clinical presentation on admission. Blood lactate levels were always higher with or without septic shock and indifferent of kidney function.http://link.springer.com/article/10.1186/s13613-017-0336-8MetforminSeptic shockDiabetesLactic acidosisICU |
| spellingShingle | Sebastien Jochmans Jean-Emmanuel Alphonsine Jonathan Chelly Ly Van Phach Vong Oumar Sy Nathalie Rolin Olivier Ellrodt Mehran Monchi Christophe Vinsonneau Does metformin exposure before ICU stay have any impact on patients’ outcome? A retrospective cohort study of diabetic patients Annals of Intensive Care Metformin Septic shock Diabetes Lactic acidosis ICU |
| title | Does metformin exposure before ICU stay have any impact on patients’ outcome? A retrospective cohort study of diabetic patients |
| title_full | Does metformin exposure before ICU stay have any impact on patients’ outcome? A retrospective cohort study of diabetic patients |
| title_fullStr | Does metformin exposure before ICU stay have any impact on patients’ outcome? A retrospective cohort study of diabetic patients |
| title_full_unstemmed | Does metformin exposure before ICU stay have any impact on patients’ outcome? A retrospective cohort study of diabetic patients |
| title_short | Does metformin exposure before ICU stay have any impact on patients’ outcome? A retrospective cohort study of diabetic patients |
| title_sort | does metformin exposure before icu stay have any impact on patients outcome a retrospective cohort study of diabetic patients |
| topic | Metformin Septic shock Diabetes Lactic acidosis ICU |
| url | http://link.springer.com/article/10.1186/s13613-017-0336-8 |
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