Evidence mapPaperPMID 29198069Full record

ArticleAnnals of intensive care2017

Does metformin exposure before ICU stay have any impact on patients' outcome? A retrospective cohort study of diabetic patients.

Sebastien Jochmans, Jean-Emmanuel Alphonsine, Jonathan Chelly, Ly Van Phach Vong, Oumar Sy, Nathalie Rolin, Olivier Ellrodt, Mehran Monchi, Christophe Vinsonneau

Open access · goldAbstract read
In one paragraph

Article in Annals of intensive care, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 4 pooled it
1.8field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 4 syntheses or guidelines pooled it, 22 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Review
  6. Review
  7. Article
  8. Observational
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 1 country.

Sebastien JochmansDépartement de Médecine Intensive et Unité de Recherche Clinique, Groupe Hospitalier Sud Ile-de-France, Hôpital de Melun, 77000, Melun, France. sebastien.jochmans@gmail.com.ORCID http://orcid.org/0000-0002-7111-4107
Jean-Emmanuel AlphonsineService de Réanimation Médicale, AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France.
Jonathan ChellyDépartement de Médecine Intensive et Unité de Recherche Clinique, Groupe Hospitalier Sud Ile-de-France, Hôpital de Melun, 77000, Melun, France.
Ly Van Phach VongDépartement de Médecine Intensive, Groupe Hospitalier Sud Ile-de-France, Hôpital de Melun, 77000, Melun, France.
Oumar SyDépartement de Médecine Intensive, Groupe Hospitalier Sud Ile-de-France, Hôpital de Melun, 77000, Melun, France.
Nathalie RolinDépartement de Médecine Intensive, Groupe Hospitalier Sud Ile-de-France, Hôpital de Melun, 77000, Melun, France.
Olivier EllrodtDépartement de Médecine Intensive, Groupe Hospitalier Sud Ile-de-France, Hôpital de Melun, 77000, Melun, France.
Mehran MonchiDépartement de Médecine Intensive et Unité de Recherche Clinique, Groupe Hospitalier Sud Ile-de-France, Hôpital de Melun, 77000, Melun, France.
Christophe VinsonneauService de Réanimation Polyvalente, Hôpital de Bethune, 62408, Bethune, France.
Melun Hospital · FRAssistance Publique – Hôpitaux de Paris · FRCentre Hospitalier de Béthune · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundImpact of metformin exposure before ICU stay remains controversial. Metformin is thought to induce lactic acidosis and haemodynamic instability but may reduce ICU mortality. We evaluated its influence on outcome in diabetic patients admitted in the ICU and then compared two different populations based on the presence of septic shock.

methodsWe conducted a retrospective cohort study in a 24-bed French ICU between October 2010 and December 2013, including all ICU-admitted diabetic patients.

resultsAmong 635 diabetic patients admitted during the study period, 131 (21%) were admitted with septic shock. Multivariate analysis showed no difference in hospital mortality in all metformin users (OR 0.75 [95% CI 0.44-1.28]; p = 0.29), except in the septic shock subgroup (OR 0.61; 95% CI [0.37-0.99]; p = 0.04) despite higher vasopressor dosages in the first hours after shock onset. Blood lactate level was higher in metformin users than in non-metformin users in all patients (p < 0.001), in septic shock patients (p < 0.001) and in patients without kidney injury (p < 0.001). Metformin users did not have more septic shock from unknown aetiology (p = 0.65) or unknown pathogen (p = 0.99).

conclusionsMetformin use before admission to ICU did not affect in-hospital mortality. However, for patients with septic shock, mortality was lower, despite worse clinical presentation on admission. Blood lactate levels were always higher with or without septic shock and indifferent of kidney function.

Indexed as

DiabetesICULactic acidosisMetforminSeptic shock

Identifiers

PMID29198069
PMCPMC5712297
OpenAlexW2775580271

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.