Metformin during hospitalization associated with improved outcomes in type 2 diabetes and sepsis
In a retrospective cohort study in Pennsylvania, adults with type 2 diabetes and sepsis who were exposed to metformin during hospitalization had lower 90-day mortality and better kidney outcomes than those who were not.
Exposure to metformin during hospitalization may improve survival and other outcomes in patients with sepsis and type 2 diabetes, a recent study found.
Researchers performed a retrospective cohort study using electronic health record data from ICUs at 16 Pennsylvania hospitals to determine whether patients with type 2 diabetes and sepsis who had a metformin exposure during hospitalization did better than those who did not. Metformin exposure was defined as administration of at least one dose of metformin during the index hospitalization regardless of timing of sepsis diagnosis. The study's primary outcome was all-cause mortality at 90 days from the original sepsis diagnosis, while secondary outcomes were development of severe acute kidney injury between 24 hours before sepsis diagnosis and discharge or death; acute kidney injury recovery; and major adverse kidney events at 30, 60, and 90 days from diagnosis of acute kidney injury. Results were published Feb. 7 by Critical Care Medicine.
The study included data on 14,847 patients with type 2 diabetes and sepsis from October 2008 to December 2014. Overall, 4.6% were exposed to metformin during hospitalization and 95.4% were not. The researchers conducted propensity score matching in a 1:4 ratio in 2,691 patients, 599 with a metformin exposure and 2,092 without. Exposure to metformin was associated with lower 90-day mortality (11.9% vs. 22.7%; odds ratio [OR], 0.46 [95% CI, 0.35 to 0.60]), lower rates of severe acute kidney injury (50% vs. 57%; OR, 0.75 [95% CI, 0.62 to 0.90]), fewer major adverse kidney events (a composite of death, dialysis, and persistent kidney dysfunction) at one year (OR, 0.27; 95% CI, 0.22 to 0.68), and increased renal recovery (95% vs. 86%; OR, 6.43 [95% CI, 3.42 to 12.1]).
Most of the included patients were White, affecting generalizability, and there were no data on duration of metformin use before hospitalization, among other limitations, the authors noted. They concluded that in their study, exposure to metformin during hospitalization in adults with type 2 diabetes and sepsis was associated with lower risk-adjusted mortality at 90 days and lower rates of severe acute kidney injury. They called for additional exploration of the role of metformin as a potential specific therapy for patients with sepsis.