Livia Mueller, Michel Moser, Josef Prazak, Daniel G Fuster, Joerg C Schefold, Patrick Zuercher
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引用次数: 1
Abstract
Introduction: Metformin-treated patients may experience severe hyperlactatemia or lactic acidosis (LA). LA often requires intensive-care-unit (ICU) treatment, and mortality rates are high. Here, we investigate the impact of renal dysfunction and renal replacement therapy (RRT) on the outcomes of critically ill patients with metformin-associated LA (MALA). Furthermore, we assessed associations between mortality and metformin dose, metformin plasma/serum concentrations, lactate level, and arterial pH. Finally, we investigated whether the recommended classification in MALA, metformin-unrelated LA, metformin-induced LA, and LA in metformin therapy appears useful in this regard.
Methods: We performed a retrospective analysis based on a systematic PubMed search for publications on hyperlactatemia/LA in metformin-treated ICU patients from January 1995 to February 2020. Case-level data including demographics and clinical conditions were extracted, and logistic regression analyses were performed.
Results: A total of 92 ICU patients were reported. Two of these patients had no comorbidities interfering with lactate metabolism. In the overall group, arterial pH, lactate levels, and metformin plasma/serum concentrations were similar in survivors versus non-survivors. Ingested daily metformin doses and plasma/serum creatinine levels were significantly higher in survivors versus non-survivors (p = 0.007 vs. p = 0.024, respectively). Higher plasma/serum creatinine levels, higher lactate levels, and lower arterial pH were all associated with patients receiving RRT (all p < 0.05). Overall mortality was 22% (20 out of 92 patients) and did not differ between the RRT and non-RRT groups.
Conclusion: Mortality is high in ICU patients with metformin-associated hyperlactatemia/LA. Unexpectedly, higher ingested metformin dose and plasma/serum creatinine were associated with a better outcome. Survival was similar in patients with or without need for RRT.
二甲双胍治疗的患者可能会出现严重的高乳酸血症或乳酸酸中毒(LA)。洛杉矶通常需要重症监护病房(ICU)治疗，死亡率很高。在这里，我们研究肾功能障碍和肾脏替代治疗(RRT)对二甲双胍相关性LA (MALA)危重患者预后的影响。此外，我们评估了死亡率与二甲双胍剂量、二甲双胍血浆/血清浓度、乳酸水平和动脉ph之间的关系。最后，我们调查了二甲双胍治疗中MALA、二甲双胍无关LA、二甲双胍诱导LA和LA的推荐分类在这方面是否有用。方法:我们基于PubMed系统检索1995年1月至2020年2月二甲双胍治疗的ICU患者高乳酸血症/LA的出版物进行回顾性分析。提取病例级数据，包括人口统计学和临床情况，并进行logistic回归分析。结果:共报告ICU患者92例。其中2例患者没有干扰乳酸代谢的合并症。在整个组中，幸存者与非幸存者的动脉pH值、乳酸水平和二甲双胍血浆/血清浓度相似。幸存者与非幸存者相比，每日摄取的二甲双胍剂量和血浆/血清肌酐水平显著更高(p = 0.007 vs. p = 0.024)。较高的血浆/血清肌酐水平、较高的乳酸水平和较低的动脉pH值均与接受RRT的患者相关(均p < 0.05)。总死亡率为22%(92例患者中有20例)，在RRT组和非RRT组之间没有差异。结论:二甲双胍相关性高乳酸血症/LA在ICU患者中死亡率较高。出乎意料的是，较高的二甲双胍摄入剂量和血浆/血清肌酐与较好的结果相关。需要或不需要RRT的患者的生存率相似。
期刊介绍：
''Pharmacology'' is an international forum to present and discuss current perspectives in drug research. The journal communicates research in basic and clinical pharmacology and related fields. It covers biochemical pharmacology, molecular pharmacology, immunopharmacology, drug metabolism, pharmacogenetics, analytical toxicology, neuropsychopharmacology, pharmacokinetics and clinical pharmacology. In addition to original papers and short communications of investigative findings and pharmacological profiles the journal contains reviews, comments and perspective notes; research communications of novel therapeutic agents are encouraged.
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