Evidence mapPaperPMID 32170333Full record

ArticleEuropean journal of clinical pharmacology2020

Extracorporeal treatment of metforminassociated lactic acidosis in clinical practice: a retrospective cohort study.

Inge R F van Berlo-van de Laar, Cornelis G Vermeij, Marjo van den Elsen-Hutten, Arthur de Meijer, Katja Taxis, Frank G A Jansman

Open access · hybridAbstract read
In one paragraph

Article in European journal of clinical pharmacology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.5field-weighted citation impact, top 31% 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

0 citing papers in PubMed, 5 citations in OpenAlex.

No citing paper in PubMed yet.

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

6 authors at 2 institutions in 1 country.

Inge R F van Berlo-van de LaarDepartment of Clinical Pharmacy, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, P.O. Box 5001, 7400 GC, Deventer, The Netherlands. i.vanberlo-vandelaar@dz.nl.ORCID https://orcid.org/0000-0003-3643-6706
Cornelis G VermeijDepartment of Internal Medicine, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands.
Marjo van den Elsen-HuttenDepartment of Research and Innovation, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands.
Arthur de MeijerDepartment of Intensive Care, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands.
Katja TaxisUnit of PharmacoTherapy, -Epidemiology &-Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
Frank G A JansmanDepartment of Clinical Pharmacy, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, P.O. Box 5001, 7400 GC, Deventer, The Netherlands.
Deventer Ziekenhuis · NLUniversity of Groningen · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo assess whether extracorporeal treatment (ECTR) improves outcome of patients with metformin-associated lactic acidosis (MALA) and to evaluate the clinical applicability of the Extracorporeal Treatments in Poisoning Workgroup (EXTRIP) criteria for starting ECTR in metformin poisoning.

methodsPatients with metformin serum concentrations above 2 mg/l who were admitted in the Deventer Teaching Hospital between January 2000 and July 2019 and complied with the definition of MALA (pH < 7.35 and lactate concentration > 5 mmol/l) were included. Mortality and clinical parameters of patients treated with ECTR or not were compared. In addition, treatment of MALA in clinical practice was verified against the criteria of EXTRIP.

resultsForty-two patients were included. Lactate (13.8 versus 10.5 mmol/l, p = 0.01), creatinine (575 versus 254 umol/l, p < 0.01)), metformin (29.4 versus 8.6 mg/l, p < 0.01) concentrations, and vasopressor requirement (72% versus 23%, p < 0.01) were significantly higher in the ECTR-group. Blood pH (7.05 versus 7.19, p = 0.03) and bicarbonate (6 versus 11 mmol/l, p < 0.01) were significantly lower. Mortality, length of hospital stay, and mechanical ventilation requirement were not statistically different. In 83% of patients, treatment of MALA was in accordance with the EXTRIP criteria.

conclusionsAlthough there was no statistical benefit in mortality shown from ECTR, ECTR might be lifesaving in MALA, considering the ECTR-group was significantly sicker than the non-ECTR-group. The majority of patients were treated in line with the EXTRIP criteria. Severity of lactic acidosis and renal impairment were the main indications for initiating ECTR.

Indexed as

Acidosis, LacticAgedAged, 80 and overFemaleHumansMaleMetforminMiddle AgedRenal DialysisRetrospective StudiesMetforminExtracorporeal treatmentLactic acidosisMetforminRenal impairment

Identifiers

PMID32170333
PMCPMC7239820
OpenAlexW3011648786

What Socratic holds

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Registered trials

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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.