Abstract
BackgroundRecent studies have reported that preadmission metformin users had lower mortality than non-metformin users in patients with sepsis and diabetes mellitus; however, these results are still controversial. Therefore, we conducted a systematic review and meta-analysis of published observational cohort data to determine the association between preadmission metformin use and mortality in septic adult patients with diabetes mellitus.MethodsThe MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched from their inception to September 30, 2018. Cohort studies that evaluated the use of metformin in septic adult patients with diabetes mellitus were included. The quality of outcomes was evaluated using the Newcastle-Ottawa Scale (NOS). The inverse variance method with random effects modelling was used to calculate the pooled odds ratios (ORs) and 95% CIs.ResultsFive observational cohort studies (1282 patients) that were all judged as having a low risk of bias were included. In this meta-analysis, metformin use was associated with a significantly lower mortality rate (OR, 0.59; 95% CI, 0.43–0.79, P = 0.001).ConclusionsThis meta-analysis indicated an association between metformin use prior to admission and lower mortality in septic adult patients with diabetes mellitus. This finding suggested that the possible effect of metformin should be evaluated in future clinical trials.
Highlights
Sepsis is a life-threatening organ dysfunction caused by dysregulated host responses to infection [1]
The exact mechanism remains unclear, but it is widely postulated that the release of inflammatory factors by innate immune cells plays an important role in sepsis disease pathogenesis [4, 5]
Eligibility criteria Studies were considered suitable for inclusion in this meta-analysis if (1) they enrolled septic patients with diabetes mellitus who used metformin, (2) the comparative arms were septic patients with or without diabetes mellitus, (3) they measured the mortality of metformin users and non-metformin users, (4) all the patients were adults, (5) they were observational studies from all settings, and (6) they were written in English
Summary
Sepsis is a life-threatening organ dysfunction caused by dysregulated host responses to infection [1]. Because the high mortality due to sepsis remains a major medical problem [2, 3], exploring the mechanism of its development is important. In addition to its well-known hypoglycaemic activities, increasing evidence has suggested that metformin inhibits the expression of pro-inflammatory factors in vitro and ameliorates inflammatory injuries in vivo [9,10,11,12,13,14]. Recent studies have reported that preadmission metformin users had lower mortality than non-metformin users in patients with sepsis and diabetes mellitus; these results are still controversial. We conducted a systematic review and meta-analysis of published observational cohort data to determine the association between preadmission metformin use and mortality in septic adult patients with diabetes mellitus
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
