Impact of metformin use on the prognostic value of lactate in sepsis

Jeffrey P. Green, Tony Berger, Nidhi Garg, Alison Suarez, Yolanda Hagar, Michael S. Radeos, Edward A Panacek

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1667-1673
Number of pages7
JournalAmerican Journal of Emergency Medicine
Volume30
Issue number9
DOIs
StatePublished - Nov 2012

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Metformin
Lactic Acid
Sepsis
Hospital Emergency Service
Mortality
Odds Ratio
Organ Dysfunction Scores
Systemic Inflammatory Response Syndrome
Urban Hospitals
Infection
Teaching Hospitals
Medical Records
Cohort Studies
Multivariate Analysis
Retrospective Studies
Demography
Hyperlactatemia

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Impact of metformin use on the prognostic value of lactate in sepsis. / Green, Jeffrey P.; Berger, Tony; Garg, Nidhi; Suarez, Alison; Hagar, Yolanda; Radeos, Michael S.; Panacek, Edward A.

In: American Journal of Emergency Medicine, Vol. 30, No. 9, 11.2012, p. 1667-1673.

Research output: Contribution to journalArticle

Green, Jeffrey P. ; Berger, Tony ; Garg, Nidhi ; Suarez, Alison ; Hagar, Yolanda ; Radeos, Michael S. ; Panacek, Edward A. / Impact of metformin use on the prognostic value of lactate in sepsis. In: American Journal of Emergency Medicine. 2012 ; Vol. 30, No. 9. pp. 1667-1673.
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abstract = "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.",
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T1 - Impact of metformin use on the prognostic value of lactate in sepsis

AU - Green, Jeffrey P.

AU - Berger, Tony

AU - Garg, Nidhi

AU - Suarez, Alison

AU - Hagar, Yolanda

AU - Radeos, Michael S.

AU - Panacek, Edward A

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N2 - 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.

AB - 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.

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