二甲双胍在 ICU 患者高乳酸血症和乳酸性酸中毒中的作用：系统评价。

Metformin's Role in Hyperlactatemia and Lactic Acidosis in ICU Patients: A Systematic Review.

机构信息

Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

出版信息

Pharmacology. 2023;108(3):213-223. doi: 10.1159/000528252. Epub 2023 Jan 18.

DOI:10.1159/000528252

PMID:36652938

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10233707/

Abstract

INTRODUCTION

Metformin-treated patients may experience severe hyperlactatemia or lactic acidosis (LA). LA often requires intensive-care-unit (ICU) treatment, and mortality rates are high. Here, we investigate the impact of renal dysfunction and renal replacement therapy (RRT) on the outcomes of critically ill patients with metformin-associated LA (MALA). Furthermore, we assessed associations between mortality and metformin dose, metformin plasma/serum concentrations, lactate level, and arterial pH. Finally, we investigated whether the recommended classification in MALA, metformin-unrelated LA, metformin-induced LA, and LA in metformin therapy appears useful in this regard.

METHODS

We performed a retrospective analysis based on a systematic PubMed search for publications on hyperlactatemia/LA in metformin-treated ICU patients from January 1995 to February 2020. Case-level data including demographics and clinical conditions were extracted, and logistic regression analyses were performed.

RESULTS

A total of 92 ICU patients were reported. Two of these patients had no comorbidities interfering with lactate metabolism. In the overall group, arterial pH, lactate levels, and metformin plasma/serum concentrations were similar in survivors versus non-survivors. Ingested daily metformin doses and plasma/serum creatinine levels were significantly higher in survivors versus non-survivors (p = 0.007 vs. p = 0.024, respectively). Higher plasma/serum creatinine levels, higher lactate levels, and lower arterial pH were all associated with patients receiving RRT (all p < 0.05). Overall mortality was 22% (20 out of 92 patients) and did not differ between the RRT and non-RRT groups.

CONCLUSION

Mortality is high in ICU patients with metformin-associated hyperlactatemia/LA. Unexpectedly, higher ingested metformin dose and plasma/serum creatinine were associated with a better outcome. Survival was similar in patients with or without need for RRT.

摘要

介绍

接受二甲双胍治疗的患者可能会出现严重的高乳酸血症或乳酸性酸中毒（LA）。LA 通常需要重症监护病房（ICU）治疗，死亡率很高。在这里，我们研究了肾功能障碍和肾脏替代治疗（RRT）对合并二甲双胍相关 LA（MALA）的危重症患者结局的影响。此外，我们评估了死亡率与二甲双胍剂量、二甲双胍血浆/血清浓度、乳酸水平和动脉 pH 值之间的相关性。最后，我们研究了推荐的 MALA、与二甲双胍无关的 LA、二甲双胍诱导的 LA 和二甲双胍治疗中的 LA 分类在这方面是否有用。

方法

我们基于 1995 年 1 月至 2020 年 2 月期间在 PubMed 上发表的关于接受 ICU 治疗的接受二甲双胍治疗的高乳酸血症/LA 患者的文献进行了系统回顾分析。提取病例级数据，包括人口统计学和临床情况，并进行逻辑回归分析。

结果

共报告了 92 例 ICU 患者。其中 2 例患者没有干扰乳酸代谢的合并症。在总体组中，幸存者与非幸存者的动脉 pH 值、乳酸水平和二甲双胍血浆/血清浓度相似。幸存者的每日摄入二甲双胍剂量和血浆/血清肌酐水平明显高于非幸存者（分别为 p = 0.007 和 p = 0.024）。更高的血浆/血清肌酐水平、更高的乳酸水平和更低的动脉 pH 值均与接受 RRT 的患者相关（均 p < 0.05）。总体死亡率为 22%（92 例患者中有 20 例），RRT 组和非 RRT 组之间无差异。