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Critical Care

, 20:10

First Online: 15 January 2016Received: 29 August 2015Accepted: 29 December 2015


BackgroundHigh serum lactate is associated with increased mortality in septic shock patients. Metformin alters lactate metabolism, and may affect its prognostic value. We compared, between metformin users and nonusers, the prognosis of extremely elevated plasma lactate levels in patients with septic shock.

MethodsThe electronic medical records EMR of patients admitted to the emergency room between January 2011 and June 2013 were reviewed. The study cohort comprised patients with an initial diagnosis of septic shock and blood lactate higher than 10 mmol-L. The selected population was divided into two groups: metformin users exposed and metformin nonusers unexposed. The primary outcome measured was inhospital mortality.

ResultsThe study included 44 metformin users and 118 nonusers. Metformin users were similar to nonusers with respect to levels of lactate, HCO3, and blood pH; however, they were older and had higher incidence rates of cardiovascular disease and acute kidney injury at admission, compared to nonusers. Inhospital mortality rates were significantly lower in the metformin-treated group, 56.8 % vs. 88.1 %, p <0.0001.

ConclusionsThough high lactate concentration indicates poor prognosis in septic patients, mortality rate was found to be significantly lower in those who were treated with metformin. This finding may help clinicians in deciding treatment for these patients, who could otherwise be considered too ill for real treatment benefit.

KeywordsLactic acidosis Metformin Septic shock Acute kidney injury AbbreviationsAKIAcute kidney injury

AMPKAMP-activated protein kinase

APACHEAcute physiology and chronic health evaluation

CKDchronic kidney disease

EMRElectronic medical records

EREmergency room

ICUIntensive care unit

MALAMetformin-associated lactic acidosis

MILAMetformin-induced lactic acidosis

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Autor: Keren Doenyas-Barak - Ilia Beberashvili - Ronit Marcus - Shai Efrati


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