General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, 450052, China.
Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Crit Care. 2019 Feb 18;23(1):50. doi: 10.1186/s13054-019-2346-4.
Recent 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.
The 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.
Five 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).
This 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.
最近的研究报告称，在患有败血症和糖尿病的患者中，入院前使用二甲双胍的患者死亡率低于未使用二甲双胍的患者；然而，这些结果仍存在争议。因此，我们对已发表的观察性队列数据进行了系统评价和荟萃分析，以确定入院前使用二甲双胍与成年糖尿病败血症患者死亡率之间的关系。
从数据库建立到 2018 年 9 月 30 日，我们检索了 MEDLINE、EMBASE 和 Cochrane CENTRAL 数据库。纳入评估二甲双胍在成年糖尿病败血症患者中使用的队列研究。使用纽卡斯尔-渥太华量表（NOS）评估结局质量。使用随机效应模型的逆方差法计算汇总比值比（OR）和 95%置信区间（CI）。
纳入了 5 项观察性队列研究（1282 名患者），所有研究均被认为具有低偏倚风险。在这项荟萃分析中，二甲双胍的使用与死亡率显著降低相关（OR，0.59；95%CI，0.43-0.79，P=0.001）。
这项荟萃分析表明，在患有糖尿病的败血症成年患者中，入院前使用二甲双胍与死亡率降低有关。这一发现表明，在未来的临床试验中应评估二甲双胍的可能作用。
