Association Between Preadmission Metformin Use and Outcomes in Intensive Care Unit Patients With Sepsis and Type 2 Diabetes: A Cohort Study

Qilin Yang; Jiezhao Zheng; Weiyan Chen; Xiaohua Chen; Deliang Wen; Weixiao Chen; Xuming Xiong; Zhenhui Zhang

doi:10.3389/fmed.2021.640785

Association Between Preadmission Metformin Use and Outcomes in Intensive Care Unit Patients With Sepsis and Type 2 Diabetes: A Cohort Study

Front Med (Lausanne). 2021 Mar 29:8:640785. doi: 10.3389/fmed.2021.640785. eCollection 2021.

Authors

Qilin Yang¹, Jiezhao Zheng¹, Weiyan Chen¹, Xiaohua Chen¹, Deliang Wen¹, Weixiao Chen¹, Xuming Xiong¹, Zhenhui Zhang¹

Affiliation

¹ Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Abstract

Background: Sepsis is a deadly disease worldwide. Effective treatment strategy of sepsis remains limited. There still was a controversial about association between preadmission metformin use and mortality in sepsis patients with diabetes. We aimed to assess sepsis-related mortality in patients with type 2 diabetes (T2DM) who were preadmission metformin and non-metformin users. Methods: The patients with sepsis and T2DM were included from Medical Information Mart for Intensive Care -III database. Outcome was 30-day mortality. We used multivariable Cox regression analyses to calculate adjusted hazard ratio (HR) with 95% CI. Results: We included 2,383 sepsis patients with T2DM (476 and 1,907 patients were preadmission metformin and non-metformin uses) between 2001 and 2012. The overall 30-day mortality was 20.1% (480/2,383); it was 21.9% (418/1,907), and 13.0% (62/476) for non-metformin and metformin users, respectively. After adjusted for potential confounders, we found that preadmission metformin use was associated with 39% lower of 30-day mortality (HR = 0.61, 95% CI: 0.46-0.81, p = 0.007). In sensitivity analyses, subgroups analyses, and propensity score matching, the results remain stable. Conclusions: Preadmission metformin use may be associated with reduced risk-adjusted mortality in patients with sepsis and T2DM. It is worthy to further investigate this association.

Keywords: PSM; metformin; mortality; sepsis; type 2 diabetes.