Document Detail


Impact of metformin use on the prognostic value of lactate in sepsis.
MedLine Citation:
PMID:  22424991     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The objective of this study is to determine if metformin use affects the prevalence and prognostic value of hyperlactatemia to predict mortality in septic adult emergency department (ED) patients.
METHODS: This is a single-center retrospective cohort study. Emergency department providers identified study subjects; data were collected from the medical record.
PATIENTS: Adult ED patients with suspected infection and 2 or more systemic inflammatory response syndrome criteria were included. The outcome was 28-day mortality. The primary risk variable was serum lactate (<2.0, 2.0-3.9, ≥ 4.0 mmol/L) categorized by metformin use; covariates: demographics, Predisposition, Infection, Response, Organ Dysfunction score and metformin use contraindications.
SETTING: The study was conducted at an urban teaching hospital; February 1, 2007 to October 31, 2008.
RESULTS: A total of 1947 ED patients were enrolled; 192 (10%) were taking metformin; 305 (16%) died within 28 days. Metformin users had higher median lactate levels than nonusers (2.2 mmol/L [interquartile range, 1.6-3.2] vs 1.9 mmol/L [interquartile range, 1.3-2.8]) and a higher, although nonsignificant, prevalence of hyperlactatemia (lactate ≥ 4.0 mmol/L) (17% vs 13%) (P = .17). In multivariate analysis (reference group nonmetformin users, lactate <2.0 mmol/L), hyperlactatemia was associated with an increased adjusted 28-day mortality risk among nonmetformin users (odds ratio [OR], 3.18; P < .01) but not among metformin users (OR, 0.54; P = .33). In addition, nonmetformin users had a higher adjusted mortality risk than metformin users (OR, 2.49; P < .01). These differences remained significant when only diabetic patients were analyzed.
CONCLUSIONS: In this study of adult ED patients with suspected sepsis, metformin users had slightly higher median lactate levels and prevalence of hyperlactatemia. However, hyperlactatemia did not predict an increased mortality risk in patients taking metformin.
Authors:
Jeffrey P Green; Tony Berger; Nidhi Garg; Alison Suarez; Yolanda Hagar; Michael S Radeos; Edward A Panacek
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-03-16
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  30     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-19     Completed Date:  2013-03-12     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1667-73     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Emergency Service, Hospital
Female
Humans
Hypoglycemic Agents / pharmacology*
Lactates / blood*
Logistic Models
Male
Metformin / pharmacology*
Predictive Value of Tests
Prognosis
Retrospective Studies
Sepsis / blood,  diagnosis*,  mortality
Grant Support
ID/Acronym/Agency:
2UL 1RR024146/RR/NCRR NIH HHS; UL1 RR024146/RR/NCRR NIH HHS; UL1 RR024146-01/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Hypoglycemic Agents; 0/Lactates; 9100L32L2N/Metformin
Comments/Corrections

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