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Abstract：
UNASSIGNED: The objective of this study was to investigate the correlation between metformin exposure and the incidence of lactic acidosis in critically ill patients.
UNASSIGNED: The patients with type 2 diabetes mellitus (T2DM) were included from Medical Information Mart for Intensive Care IV database (MIMIC-IV). The primary outcome was the incidence of lactic acidosis. The secondary outcomes were lactate level and in-hospital mortality. Propensity score matching (PSM) method was adopted to reduce bias of the confounders. The multivariate logistic regression was used to explore the correlation between metformin exposure and the incidence of lactic acidosis. Subgroup analysis and sensitivity analysis were used to test the stability of the conclusion.
UNASSIGNED: We included 4939 patients. There were 2070 patients in the metformin group, and 2869 patients in the nonmetformin group. The frequency of lactic acidosis was 5.7% (118/2070) in the metformin group and it was 4.3% (122/2869) in the nonmetformin group. There was a statistically significant difference between the two groups (P < 0.05). The lactate level in the metformin group was higher than in the nonmetformin group (2.78 ± 2.23 vs. 2.45 ± 2.24, P < 0.001). After PSM, the frequency of lactic acidosis (6.3% vs. 3.7%, P < 0.001) and lactate level (2.85 ± 2.38 vs. 2.40 ± 2.14, P < 0.001) were significantly higher in the metformin group compared with the nonmetformin group. In multivariate logistic models, the frequency of lactic acidosis was obviously increased in metformin group, and the adjusted odds ratio (OR) of metformin exposure was 1.852 (95% confidence interval (CI) = 1.298-2.643, P < 0.001). The results were consistent with subgroup analysis except for respiratory failure subgroup. Metformin exposure increased lactate level but did not affect the frequency of lactic acidosis in patients of respiratory failure with hypercapnia. However, the in-hospital mortality between metformin and nonmetformin group had no obvious difference (P = 0.215). In sensitivity analysis, metformin exposure showed similar effect as the original cohort.
UNASSIGNED: In critically ill patients with T2DM, metformin exposure elevated the incidence of lactic acidosis except for patients of respiratory failure with hypercapnia, but did not affect the in-hospital mortality.
UNASSIGNED: The patients with type 2 diabetes mellitus (T2DM) were included from Medical Information Mart for Intensive Care IV database (MIMIC-IV). The primary outcome was the incidence of lactic acidosis. The secondary outcomes were lactate level and in-hospital mortality. Propensity score matching (PSM) method was adopted to reduce bias of the confounders. The multivariate logistic regression was used to explore the correlation between metformin exposure and the incidence of lactic acidosis. Subgroup analysis and sensitivity analysis were used to test the stability of the conclusion.
UNASSIGNED: We included 4939 patients. There were 2070 patients in the metformin group, and 2869 patients in the nonmetformin group. The frequency of lactic acidosis was 5.7% (118/2070) in the metformin group and it was 4.3% (122/2869) in the nonmetformin group. There was a statistically significant difference between the two groups (P < 0.05). The lactate level in the metformin group was higher than in the nonmetformin group (2.78 ± 2.23 vs. 2.45 ± 2.24, P < 0.001). After PSM, the frequency of lactic acidosis (6.3% vs. 3.7%, P < 0.001) and lactate level (2.85 ± 2.38 vs. 2.40 ± 2.14, P < 0.001) were significantly higher in the metformin group compared with the nonmetformin group. In multivariate logistic models, the frequency of lactic acidosis was obviously increased in metformin group, and the adjusted odds ratio (OR) of metformin exposure was 1.852 (95% confidence interval (CI) = 1.298-2.643, P < 0.001). The results were consistent with subgroup analysis except for respiratory failure subgroup. Metformin exposure increased lactate level but did not affect the frequency of lactic acidosis in patients of respiratory failure with hypercapnia. However, the in-hospital mortality between metformin and nonmetformin group had no obvious difference (P = 0.215). In sensitivity analysis, metformin exposure showed similar effect as the original cohort.
UNASSIGNED: In critically ill patients with T2DM, metformin exposure elevated the incidence of lactic acidosis except for patients of respiratory failure with hypercapnia, but did not affect the in-hospital mortality.
摘要：
■本研究的目的是探讨二甲双胍暴露与危重患者乳酸性酸中毒发生率之间的相关性。
■2型糖尿病（T2DM）患者来自医学信息集市重症监护IV数据库（MIMIC-IV）。主要结果是乳酸性酸中毒的发生率。次要结局是乳酸水平和院内死亡率。采用倾向得分匹配(PSM)方法减少混杂因素的偏倚。采用多因素logistic回归分析二甲双胍暴露与乳酸性酸中毒发生率的相关性。采用亚组分析和敏感性分析检验结论的稳定性。
■我们纳入了4939例患者。二甲双胍组有2070例患者，非二甲双胍组2869例患者。二甲双胍组乳酸酸中毒的发生率为5.7％（118/2070），非二甲双胍组为4.3％（122/2869）。两组比较差异有统计学意义(P<0.05)。二甲双胍组的乳酸水平高于非二甲双胍组（2.78±2.23vs.2.45±2.24,P<0.001)。PSM之后,乳酸性酸中毒的频率(6.3%vs.3.7%,P<0.001）和乳酸水平（2.85±2.38vs.二甲双胍组的2.40±2.14，P<0.001）明显高于非二甲双胍组。在多变量逻辑模型中，二甲双胍组乳酸性酸中毒频率明显增加,二甲双胍暴露的校正比值比（OR）为1.852（95％置信区间（CI）=1.298-2.643，P<0.001）。除呼吸衰竭亚组外，结果与亚组分析一致。二甲双胍暴露会增加高碳酸血症呼吸衰竭患者的乳酸水平，但不会影响乳酸酸中毒的频率。然而,二甲双胍组和非二甲双胍组的住院死亡率无明显差异(P=0.215).在敏感性分析中，二甲双胍暴露显示与原始队列相似的效果。
■在T2DM的危重患者中，二甲双胍暴露会增加乳酸性酸中毒的发生率，但呼吸衰竭合并高碳酸血症的患者除外，但不影响住院死亡率.
■2型糖尿病（T2DM）患者来自医学信息集市重症监护IV数据库（MIMIC-IV）。主要结果是乳酸性酸中毒的发生率。次要结局是乳酸水平和院内死亡率。采用倾向得分匹配(PSM)方法减少混杂因素的偏倚。采用多因素logistic回归分析二甲双胍暴露与乳酸性酸中毒发生率的相关性。采用亚组分析和敏感性分析检验结论的稳定性。
■我们纳入了4939例患者。二甲双胍组有2070例患者，非二甲双胍组2869例患者。二甲双胍组乳酸酸中毒的发生率为5.7％（118/2070），非二甲双胍组为4.3％（122/2869）。两组比较差异有统计学意义(P<0.05)。二甲双胍组的乳酸水平高于非二甲双胍组（2.78±2.23vs.2.45±2.24,P<0.001)。PSM之后,乳酸性酸中毒的频率(6.3%vs.3.7%,P<0.001）和乳酸水平（2.85±2.38vs.二甲双胍组的2.40±2.14，P<0.001）明显高于非二甲双胍组。在多变量逻辑模型中，二甲双胍组乳酸性酸中毒频率明显增加,二甲双胍暴露的校正比值比（OR）为1.852（95％置信区间（CI）=1.298-2.643，P<0.001）。除呼吸衰竭亚组外，结果与亚组分析一致。二甲双胍暴露会增加高碳酸血症呼吸衰竭患者的乳酸水平，但不会影响乳酸酸中毒的频率。然而,二甲双胍组和非二甲双胍组的住院死亡率无明显差异(P=0.215).在敏感性分析中，二甲双胍暴露显示与原始队列相似的效果。
■在T2DM的危重患者中，二甲双胍暴露会增加乳酸性酸中毒的发生率，但呼吸衰竭合并高碳酸血症的患者除外，但不影响住院死亡率.
