Preadmission metformin use increased the incidence of hyperlactatemia at admission and 30-day in-hospital mortality among T2D patients with heart disease at high risk of hypoxia
Surprisingly, despite the high prevalence of metformin use in type 2 diabetes (T2D) patients with heart disease, limited safety data is available regarding metformin use in patients with acute and critical heart disease. In this single-center retrospective study, patients admitted to the cardiology...
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| Veröffentlicht in: | International journal of cardiology 2024-10, Vol.412, p.132338, Article 132338 |
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| container_title | International journal of cardiology |
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| creator | Zhang, Le Zhao, Xia Wang, Zhongsu Deng, Hao Zhang, Xue Wang, Xuan Lao, Jiahui Gao, Mei Hou, Yinglong Han, Yi |
| description | Surprisingly, despite the high prevalence of metformin use in type 2 diabetes (T2D) patients with heart disease, limited safety data is available regarding metformin use in patients with acute and critical heart disease.
In this single-center retrospective study, patients admitted to the cardiology department for heart failure (HF) or acute coronary syndrome (ACS) between December 2013 and December 2021 and who underwent arterial blood gas analysis at admission with an estimated glomerular clearance rate of ≥45 ml/min/1.73 m2 were identified. The incidences of hyperlactatemia, acidosis, and 30-day in-hospital mortality were compared between preadmission metformin users and nonusers.
Of 526 admissions, 193/193 metformin users/nonusers were selected in a propensity score-matched model. Metformin users had greater lactate levels (2.55 ± 2.07 mmol/l vs. 2.00 ± 1.80 mmol/l P |
| doi_str_mv | 10.1016/j.ijcard.2024.132338 |
| format | Article |
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In this single-center retrospective study, patients admitted to the cardiology department for heart failure (HF) or acute coronary syndrome (ACS) between December 2013 and December 2021 and who underwent arterial blood gas analysis at admission with an estimated glomerular clearance rate of ≥45 ml/min/1.73 m2 were identified. The incidences of hyperlactatemia, acidosis, and 30-day in-hospital mortality were compared between preadmission metformin users and nonusers.
Of 526 admissions, 193/193 metformin users/nonusers were selected in a propensity score-matched model. Metformin users had greater lactate levels (2.55 ± 2.07 mmol/l vs. 2.00 ± 1.80 mmol/l P < 0.01), a greater incidence of hyperlactatemia [odds ratio (OR) = 2.55; 95% confidence interval (CI), 1.63–3.98; P < 0.01] and acidosis (OR = 1.78; 95% CI, 1.00–3.16; P < 0.05) at admission and a greater incidence of in-hospital mortality (OR = 3.83; 95% CI, 1.05–13.94; P < 0.05), especially those with HF/acute myocardial infarction, elderly age, or without preadmission insulin use.
Our results suggest that, compared to metformin nonusers, preadmission use of metformin may be associated with a greater incidence of hyperlactatemia and acidosis at admission and greater 30-day in-hospital mortality among T2D patients with HF or ACS at high risk of hypoxia, particularly those without preadmission insulin use. The safety of metformin in this population needs to be confirmed in prospective controlled trials.
•Safety data regarding metformin use in T2D patients with critical heart disease are limited.•Preadmission metformin is associated with a higher incidence of hyperlactatemia and death among select patients with hypoxia.•The safety of metformin in these patients at high risk of hypoxia needs to be confirmed.</description><identifier>ISSN: 0167-5273</identifier><identifier>ISSN: 1874-1754</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2024.132338</identifier><identifier>PMID: 38964551</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Acute coronary syndrome ; Arterial blood gas analysis ; Heart failure ; Hyperlactatemia ; Metformin</subject><ispartof>International journal of cardiology, 2024-10, Vol.412, p.132338, Article 132338</ispartof><rights>2024 Elsevier B.V.</rights><rights>Copyright © 2024 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c241t-4af16f0ac62601b15857b2305eb55243f40e4f6f524c4b859f777d38849d38173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijcard.2024.132338$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,46002</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38964551$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhang, Le</creatorcontrib><creatorcontrib>Zhao, Xia</creatorcontrib><creatorcontrib>Wang, Zhongsu</creatorcontrib><creatorcontrib>Deng, Hao</creatorcontrib><creatorcontrib>Zhang, Xue</creatorcontrib><creatorcontrib>Wang, Xuan</creatorcontrib><creatorcontrib>Lao, Jiahui</creatorcontrib><creatorcontrib>Gao, Mei</creatorcontrib><creatorcontrib>Hou, Yinglong</creatorcontrib><creatorcontrib>Han, Yi</creatorcontrib><title>Preadmission metformin use increased the incidence of hyperlactatemia at admission and 30-day in-hospital mortality among T2D patients with heart disease at high risk of hypoxia</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>Surprisingly, despite the high prevalence of metformin use in type 2 diabetes (T2D) patients with heart disease, limited safety data is available regarding metformin use in patients with acute and critical heart disease.
In this single-center retrospective study, patients admitted to the cardiology department for heart failure (HF) or acute coronary syndrome (ACS) between December 2013 and December 2021 and who underwent arterial blood gas analysis at admission with an estimated glomerular clearance rate of ≥45 ml/min/1.73 m2 were identified. The incidences of hyperlactatemia, acidosis, and 30-day in-hospital mortality were compared between preadmission metformin users and nonusers.
Of 526 admissions, 193/193 metformin users/nonusers were selected in a propensity score-matched model. Metformin users had greater lactate levels (2.55 ± 2.07 mmol/l vs. 2.00 ± 1.80 mmol/l P < 0.01), a greater incidence of hyperlactatemia [odds ratio (OR) = 2.55; 95% confidence interval (CI), 1.63–3.98; P < 0.01] and acidosis (OR = 1.78; 95% CI, 1.00–3.16; P < 0.05) at admission and a greater incidence of in-hospital mortality (OR = 3.83; 95% CI, 1.05–13.94; P < 0.05), especially those with HF/acute myocardial infarction, elderly age, or without preadmission insulin use.
Our results suggest that, compared to metformin nonusers, preadmission use of metformin may be associated with a greater incidence of hyperlactatemia and acidosis at admission and greater 30-day in-hospital mortality among T2D patients with HF or ACS at high risk of hypoxia, particularly those without preadmission insulin use. The safety of metformin in this population needs to be confirmed in prospective controlled trials.
•Safety data regarding metformin use in T2D patients with critical heart disease are limited.•Preadmission metformin is associated with a higher incidence of hyperlactatemia and death among select patients with hypoxia.•The safety of metformin in these patients at high risk of hypoxia needs to be confirmed.</description><subject>Acute coronary syndrome</subject><subject>Arterial blood gas analysis</subject><subject>Heart failure</subject><subject>Hyperlactatemia</subject><subject>Metformin</subject><issn>0167-5273</issn><issn>1874-1754</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kctu1DAUhi0EokPhDRDykk0GX-Nkg4QKFKRKsChry7FPGg9JHGwPMI_FG9YhA-zY-Njyf9HRh9BzSvaU0PrVYe8P1kS3Z4SJPeWM8-YB2tFGiYoqKR6iXZGpSjLFL9CTlA6EENG2zWN0wZu2FlLSHfr1OYJxk0_JhxlPkPsQJz_jYwLsZ1s-Ezich98v72C2gEOPh9MCcTQ2mwyTN9hk_C_FzA5zUjlzKqZqCGnx2Yx4CrEMn0_YTGG-w7fsLV5M9jDnhH_4POABTMzY-bS2rpmDvxtw9OnruTP89OYpetSbMcGz87xEX96_u736UN18uv549eamskzQXAnT07onxtasJrSjspGqY5xI6KRkgveCgOjrvtyt6BrZ9kopx5tGtOWkil-il1vuEsO3I6Ssy34WxtHMEI5Jc6JKsJKMFKnYpDaGlCL0eol-MvGkKdErLH3QGyy9wtIbrGJ7cW44dhO4v6Y_dIrg9SaAsud3D1En61cEzkewWbvg_99wD9yJqaw</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Zhang, Le</creator><creator>Zhao, Xia</creator><creator>Wang, Zhongsu</creator><creator>Deng, Hao</creator><creator>Zhang, Xue</creator><creator>Wang, Xuan</creator><creator>Lao, Jiahui</creator><creator>Gao, Mei</creator><creator>Hou, Yinglong</creator><creator>Han, Yi</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20241001</creationdate><title>Preadmission metformin use increased the incidence of hyperlactatemia at admission and 30-day in-hospital mortality among T2D patients with heart disease at high risk of hypoxia</title><author>Zhang, Le ; Zhao, Xia ; Wang, Zhongsu ; Deng, Hao ; Zhang, Xue ; Wang, Xuan ; Lao, Jiahui ; Gao, Mei ; Hou, Yinglong ; Han, Yi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c241t-4af16f0ac62601b15857b2305eb55243f40e4f6f524c4b859f777d38849d38173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acute coronary syndrome</topic><topic>Arterial blood gas analysis</topic><topic>Heart failure</topic><topic>Hyperlactatemia</topic><topic>Metformin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhang, Le</creatorcontrib><creatorcontrib>Zhao, Xia</creatorcontrib><creatorcontrib>Wang, Zhongsu</creatorcontrib><creatorcontrib>Deng, Hao</creatorcontrib><creatorcontrib>Zhang, Xue</creatorcontrib><creatorcontrib>Wang, Xuan</creatorcontrib><creatorcontrib>Lao, Jiahui</creatorcontrib><creatorcontrib>Gao, Mei</creatorcontrib><creatorcontrib>Hou, Yinglong</creatorcontrib><creatorcontrib>Han, Yi</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Le</au><au>Zhao, Xia</au><au>Wang, Zhongsu</au><au>Deng, Hao</au><au>Zhang, Xue</au><au>Wang, Xuan</au><au>Lao, Jiahui</au><au>Gao, Mei</au><au>Hou, Yinglong</au><au>Han, Yi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preadmission metformin use increased the incidence of hyperlactatemia at admission and 30-day in-hospital mortality among T2D patients with heart disease at high risk of hypoxia</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2024-10-01</date><risdate>2024</risdate><volume>412</volume><spage>132338</spage><pages>132338-</pages><artnum>132338</artnum><issn>0167-5273</issn><issn>1874-1754</issn><eissn>1874-1754</eissn><abstract>Surprisingly, despite the high prevalence of metformin use in type 2 diabetes (T2D) patients with heart disease, limited safety data is available regarding metformin use in patients with acute and critical heart disease.
In this single-center retrospective study, patients admitted to the cardiology department for heart failure (HF) or acute coronary syndrome (ACS) between December 2013 and December 2021 and who underwent arterial blood gas analysis at admission with an estimated glomerular clearance rate of ≥45 ml/min/1.73 m2 were identified. The incidences of hyperlactatemia, acidosis, and 30-day in-hospital mortality were compared between preadmission metformin users and nonusers.
Of 526 admissions, 193/193 metformin users/nonusers were selected in a propensity score-matched model. Metformin users had greater lactate levels (2.55 ± 2.07 mmol/l vs. 2.00 ± 1.80 mmol/l P < 0.01), a greater incidence of hyperlactatemia [odds ratio (OR) = 2.55; 95% confidence interval (CI), 1.63–3.98; P < 0.01] and acidosis (OR = 1.78; 95% CI, 1.00–3.16; P < 0.05) at admission and a greater incidence of in-hospital mortality (OR = 3.83; 95% CI, 1.05–13.94; P < 0.05), especially those with HF/acute myocardial infarction, elderly age, or without preadmission insulin use.
Our results suggest that, compared to metformin nonusers, preadmission use of metformin may be associated with a greater incidence of hyperlactatemia and acidosis at admission and greater 30-day in-hospital mortality among T2D patients with HF or ACS at high risk of hypoxia, particularly those without preadmission insulin use. The safety of metformin in this population needs to be confirmed in prospective controlled trials.
•Safety data regarding metformin use in T2D patients with critical heart disease are limited.•Preadmission metformin is associated with a higher incidence of hyperlactatemia and death among select patients with hypoxia.•The safety of metformin in these patients at high risk of hypoxia needs to be confirmed.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>38964551</pmid><doi>10.1016/j.ijcard.2024.132338</doi></addata></record> |
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| subjects | Acute coronary syndrome Arterial blood gas analysis Heart failure Hyperlactatemia Metformin |
| title | Preadmission metformin use increased the incidence of hyperlactatemia at admission and 30-day in-hospital mortality among T2D patients with heart disease at high risk of hypoxia |
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