Yang Yunlin, Liu Jinfeng, Hou Yi, Wei Yuxun, Huang Liang, Wei Wei
Department of Clinical Pharmacy, Shifang People's Hospital, Shifang, Sichuan, China.
Department of Pharmacy, People's Hospital of Zhongjiang County, Deyang, China.
Front Pharmacol. 2025 Aug 26;16:1584230. doi: 10.3389/fphar.2025.1584230. eCollection 2025.
The aim of this study was to investigate the association of metformin use with the risk of in-hospital mortality and prognosis in acute respiratory failure (ARF) patients admitted to the intensive care unit (ICU).
We conducted a retrospective cohort study using the MIMIC-IV database. Patients were categorized into metformin and non-metformin groups based on medication exposure. Primary outcomes were in-hospital and ICU mortality, while 30-day and 90-day all-cause mortality served as secondary endpoints. We applied Kaplan-Meier survival curves, Cox proportional hazards models, and logistic regression to assess associations. Propensity score matching (PSM) and machine learning algorithms were used for confounder adjustment and feature selection.
After PSM, 1,429 patients with ARF were included (374 metformin users; 1,055 non-users). Multivariate logistic regression revealed that metformin use was associated with significantly reduced in-hospital mortality (OR = 0.202, 95% CI: 0.123-0.317, p < 0.001) and ICU mortality (OR = 0.245, 95% CI: 0.142-0.399, p < 0.001). Cox models showed consistent reductions in 30-day (HR = 0.199, 95% CI: 0.124-0.320, p < 0.001) and 90-day (HR = 0.230, 95% CI: 0.150-0.352, p < 0.001) mortality. Kaplan-Meier curves confirmed better survival in the metformin group (p < 0.001). Subgroup analyses supported a consistent protective effect of metformin across most patient strata.
Metformin use was significantly associated with decreased short-term mortality among ICU patients with ARF. These findings suggest that metformin, beyond its glucose-lowering effects, may offer survival benefits in critically ill populations. Clinicians should consider the potential role of metformin when managing ICU patients with type 2 diabetes and ARF. Further prospective studies are warranted to confirm these findings and optimize clinical application strategies.
本研究旨在调查在重症监护病房（ICU）收治的急性呼吸衰竭（ARF）患者中，使用二甲双胍与院内死亡率及预后之间的关联。
我们使用MIMIC-IV数据库进行了一项回顾性队列研究。根据用药情况将患者分为二甲双胍组和非二甲双胍组。主要结局指标为院内死亡率和ICU死亡率，次要终点为30天和90天全因死亡率。我们应用Kaplan-Meier生存曲线、Cox比例风险模型和逻辑回归来评估关联。采用倾向评分匹配（PSM）和机器学习算法进行混杂因素调整和特征选择。
经过PSM后，纳入了1429例ARF患者（374例使用二甲双胍者；1055例未使用者）。多因素逻辑回归显示，使用二甲双胍与院内死亡率显著降低相关（OR = 0.202，95% CI：0.123 - 0.317，p < 0.001）以及ICU死亡率降低相关（OR = 0.245，95% CI：0.142 - 0.399，p < 0.001）。Cox模型显示30天（HR = 0.199，95% CI：0.124 - 0.320，p < 0.001）和90天（HR = 0.230，95% CI：0.150 - 0.352，p < 0.001）死亡率也持续降低。Kaplan-Meier曲线证实二甲双胍组生存情况更好（p < 0.001）。亚组分析支持二甲双胍在大多数患者亚组中具有一致的保护作用。
在患有ARF的ICU患者中，使用二甲双胍与短期死亡率降低显著相关。这些发现表明，二甲双胍除了具有降糖作用外，可能对危重症人群有生存益处。临床医生在管理患有2型糖尿病和ARF的ICU患者时应考虑二甲双胍的潜在作用。需要进一步的前瞻性研究来证实这些发现并优化临床应用策略。
