Evidence map›Metformin × all-cause mortality›PMID 30777119›Full record

SynthesisCritical care (London, England)2019

Association of preadmission metformin use and mortality in patients with sepsis and diabetes mellitus: a systematic review and meta-analysis of cohort studies.

Huoyan Liang, Xianfei Ding, Lifeng Li, Tian Wang, Quancheng Kan, Lexin Wang, Tongwen Sun

Full text readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2019. The graph read 3 numbers from its abstract, feeding 2 cells of the map, but none could be read as for or against, so it casts no vote. It also reports an association that does not count as treatment evidence, such as OR 0.59 (0.43 to 0.79) for all-cause mortality. Cited by 63 papers, 6 of them syntheses that pooled it.

3numbers the graph read from it
0cells of the map it votes in
63citing papers in PubMed, 6 pooled it
–field-weighted citation impact
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.

Read, but not usablea number the graph found but could not read as for or against

All-cause mortalityan association or prognostic statement, not a treatment comparison · t2dfeeds one cell of the map
OR 0.590.43 to 0.79P = 0.001
In this meta-analysis, metformin use was associated with a significantly lower mortality rate (OR, 0.59; 95% CI, 0.43-0.79, P = 0.001).
FeedsMetformin×all-cause mortality
Costs & health-care usedirection of benefit for this outcome is not defined · against placebo · t2dfeeds one cell of the map
OR 0.590.43 to 0.79P  = 0.001
Table 2 The Newcastle-Ottawa quality assessment scale of including studies Studies Selection Comparability Assessment of outcome Total quality score First author Representativeness of exposure arm(s) Selection of the comparative arm(s) Origin of exposure source Demonstration that outcome of interest was not present at start of study Studies controlling the most important factors Studies controlling the other main factors Assessment of outcome with independency Adequacy of follow-up length (to assess outcome) Lost to follow-up acceptable (less than 10% and reported) Doenyas-Bara [ 19 ] * * * * * * * * 8 Green [ 21 ] * * * * * * * * 8 Jochmans [ 20 ] * * * * * * * * 8 Park [ 22 ] * * * * * * * * 8 van Vught [ 23 ] * * * * * - * * 7 Effects of metformin on outcomes In the five included cohort studies (1282 patients), preadmission metformin users had significantly lower mortality than nonusers among patients with sepsis (OR, 0.59; 95% CI, 0.43-0.79, P  = 0.001) (Fig. 2 ) [ 19 - 23 ].
FeedsMetformin×costs & health-care use
Costs & health-care usedirection of benefit for this outcome is not defined · against placebo · t2dfeeds one cell of the map
OR 0.590.43 to 0.79P  = 0.001
Table 2 The Newcastle-Ottawa quality assessment scale of including studies Studies Selection Comparability Assessment of outcome Total quality score First author Representativeness of exposure arm(s) Selection of the comparative arm(s) Origin of exposure source Demonstration that outcome of interest was not present at start of study Studies controlling the most important factors Studies controlling the other main factors Assessment of outcome with independency Adequacy of follow-up length (to assess outcome) Lost to follow-up acceptable (less than 10% and reported) Doenyas-Bara [ 19 ] * * * * * * * * 8 Green [ 21 ] * * * * * * * * 8 Jochmans [ 20 ] * * * * * * * * 8 Park [ 22 ] * * * * * * * * 8 van Vught [ 23 ] * * * * * - * * 7 Effects of metformin on outcomes In the five included cohort studies (1282 patients), preadmission metformin users had significantly lower mortality than nonusers among patients with sepsis (OR, 0.59; 95% CI, 0.43-0.79, P  = 0.001) (Fig. 2 ) [ 19 - 23 ].
FeedsMetformin×costs & health-care use

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Metformin×all-cause mortality

No readable resultOpen on the map →What to test next →

1 readable study in this cell: 0 favour the treatment, 1 find no difference, 0 favour the comparator.

Belief with this paper
0.50one trial · 1 family supports, 0 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT000387272,779 enrolled · 1996
HR 0.990.79 to 1.25

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Metformin×costs & health-care use

No readable resultOpen on the map →What to test next →

1 readable study in this cell: 0 favour the treatment, 1 find no difference, 0 favour the comparator.

Belief with this paper
0.25no deciding trial · 0 families support, 0 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
0 · no effect
NCT02980276535 enrolled · 2017
Δ -6.50-13.9 to 12.9

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · 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.

5 · Its place in the literature

Who cites it

63 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Pooled it
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  7. Article
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  11. Review
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  16. Review
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3 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

7 authors.

Huoyan LiangGeneral ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, 450052, China.
Xianfei DingGeneral ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, 450052, China.
Lifeng LiBiotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Tian WangBiotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Quancheng KanDepartment of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Lexin WangSchool of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia.
Tongwen SunGeneral ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, 450052, China. suntongwen@163.com.ORCID http://orcid.org/0000-0001-6536-3222

Funding

Natural Science Foundation of Henan Province 182300410369Science and Technology Innovation Talents in Universities of Henan province 16IRTSTHN021
8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundRecent studies have reported that preadmission metformin users had lower mortality than non-metformin users in patients with sepsis and diabetes mellitus; however, these results are still controversial. Therefore, we conducted a systematic review and meta-analysis of published observational cohort data to determine the association between preadmission metformin use and mortality in septic adult patients with diabetes mellitus.

methodsThe MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched from their inception to September 30, 2018. Cohort studies that evaluated the use of metformin in septic adult patients with diabetes mellitus were included. The quality of outcomes was evaluated using the Newcastle-Ottawa Scale (NOS). The inverse variance method with random effects modelling was used to calculate the pooled odds ratios (ORs) and 95% CIs.

resultsFive observational cohort studies (1282 patients) that were all judged as having a low risk of bias were included. In this meta-analysis, metformin use was associated with a significantly lower mortality rate (OR, 0.59; 95% CI, 0.43-0.79, P = 0.001).

conclusionsThis meta-analysis indicated an association between metformin use prior to admission and lower mortality in septic adult patients with diabetes mellitus. This finding suggested that the possible effect of metformin should be evaluated in future clinical trials.

Indexed as

Diabetes MellitusHospital MortalityHumansHypoglycemic AgentsMetforminObservational Studies as TopicPatient AdmissionSepsisHypoglycemic AgentsMetforminDiabetes mellitusMeta-analysisMetforminMortalitySepsisSystematic review

Identifiers

PMID30777119
PMCPMC6379943

What Socratic holds

Textfull text, public
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.