Tuberc Respir Dis.  2017 Jul;80(3):296-303. 10.4046/trd.2017.80.3.296.

Effect of Preadmission Metformin Use on Clinical Outcome of Acute Respiratory Distress Syndrome among Critically Ill Patients with Diabetes

Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. sangmin2@snu.ac.kr

Abstract

BACKGROUND
Acute respiratory distress syndrome (ARDS) is related to high mortality and morbidity. There are no proven therapeutic measures however, to improve the clinical course of ARDS, except using low tidal volume ventilation. Metformin is known to have pleiotropic effects including anti-inflammatory activity. We hypothesized that pre-admission metformin might alter the progress of ARDS among intensive care unit (ICU) patients with diabetes mellitus (DM).
METHODS
We performed a retrospective cohort study from January 1, 2005, to April 30, 2005 of patients who were admitted to the medical ICU at Seoul National University Hospital because of ARDS, and reviewed ARDS patients with DM. Metformin use was defined as prescribed within 3-month pre-admission.
RESULTS
Of 558 patients diagnosed with ARDS, 128 (23.3%) patients had diabetes and 33 patients were treated with metformin monotherapy or in combination with other antidiabetic medications. Demographic characteristics, cause of ARDS, and comorbid conditions (except chronic kidney disease) were not different between metformin users and nonusers. Several severity indexes of ARDS were similar in both groups. The 30-day mortality was 42.42% in metformin users and 55.32% in metformin nonusers. On multivariable regression analysis, use of metformin was not significantly related to a reduced 30-day mortality (adjusted β-coefficient, −0.19; 95% confidence interval, −1.76 to 1.39; p=0.816). Propensity score-matched analyses showed similar results.
CONCLUSION
Pre-admission metformin use was not associated with reduced 30-day mortality among ARDS patients with DM in our medical ICU.

Keyword

Respiratory Distress Syndrome, Adult; Diabetes Mellitus; Metformin

MeSH Terms

Cohort Studies
Critical Illness*
Diabetes Mellitus
Humans
Intensive Care Units
Kidney
Metformin*
Morinda
Mortality
Respiratory Distress Syndrome, Adult*
Retrospective Studies
Seoul
Tidal Volume
Ventilation
Metformin

Figure

  • Figure 1 Study flow. ARDS: acute respiratory distress syndrome.

  • Figure 2 The effect of preadmission metformin on 30-day mortality of acute respiratory distress syndrome patients with diabetes.


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