Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, 17020, Turkey.
Department of Internal Medicine, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey.
Ir J Med Sci. 2022 Apr;191(2):569-575. doi: 10.1007/s11845-021-02823-9. Epub 2021 Oct 29.
The effect of preadmission metformin usage (PMU) on the mortality of coronavirus disease-2019 (COVID-19) patients with diabetes is conflicting. Most studies have focused on in-hospital mortality; however, mortality after discharge also increases in COVID-19 patients.
Examining the effect of PMU on all-cause mortality, including the post-discharge period.
Patients with diabetes who were hospitalised in 2020 due to COVID-19 were included in the study. They were divided into two groups: those with a history of metformin use (MF( +)) and those without such history (MF( -)). Propensity score matching (PSM) was performed at a ratio of 1:1 for age and sex. COX regression analyses were used to demonstrate risk factors for mortality.
We investigated 4103 patients hospitalised for COVID-19. After excluding those without diabetes or with chronic liver/kidney disease, we included the remaining 586 patients, constituting 293 women (50%) with an overall mean age of 66 ± 11.9 years. After PSM analysis, the in-hospital and post-discharge mortality rates were higher in the MF( -) group though not significantly different. However, overall mortality was higher in the MF( -) group (51 (42.5%) vs. 35 (29.2%), p = 0.031). For overall mortality, the adjusted HR was 0.585 (95% CI: 0.371 - 0.920, p = 0.020) in the MF( +) group.
PMU is associated with reducing all-cause mortality. This effect starts from the in-hospital period and becomes more significant with the post-discharge period. The main limitations were the inability to evaluate the compliance with metformin and the effects of other medications due to retrospective nature.
糖尿病合并 2019 冠状病毒病（COVID-19）患者入院前使用二甲双胍（PMU）对其死亡率的影响尚无定论。大多数研究集中于住院期间死亡率，然而 COVID-19 患者出院后死亡率也会升高。
探讨 PMU 对包括出院后时期在内的全因死亡率的影响。
本研究纳入了 2020 年因 COVID-19 住院的糖尿病患者。他们被分为两组：有二甲双胍使用史（MF( +))和无使用史（MF( -))。采用年龄和性别 1:1 的倾向评分匹配（PSM）。采用 COX 回归分析显示死亡率的危险因素。
我们共调查了 4103 例因 COVID-19 住院的患者。排除无糖尿病或慢性肝/肾功能不全的患者后，我们纳入了其余 586 例患者，其中女性 293 例（50%），平均年龄 66±11.9 岁。PSM 分析后，MF( -)组的住院和出院后死亡率虽无统计学差异，但仍较高。然而，MF( -)组的总死亡率更高（51（42.5%）vs. 35（29.2%），p=0.031）。对于总死亡率，MF( +)组调整后的 HR 为 0.585（95% CI：0.371-0.920，p=0.020）。
PMU 与降低全因死亡率相关。这种影响从住院期间开始，随着出院后时期的延长而变得更加显著。主要局限性在于回顾性研究无法评估二甲双胍的依从性和其他药物的影响。
