title: Lactic acidosis and severe septic shock in metformin users: a cohort study.
abstract: BACKGROUND
  High serum lactate is associated with increased mortality in septic shock patients. Metformin alters lactate metabolism, and may affect its prognostic value. We compared, between metformin users and nonusers, the prognosis of extremely elevated plasma lactate levels in patients with septic shock.
  
  
  METHODS
  The electronic medical records (EMR) of patients admitted to the emergency room between January 2011 and June 2013 were reviewed. The study cohort comprised patients with an initial diagnosis of septic shock and blood lactate higher than 10 mmol/L. The selected population was divided into two groups: metformin users (exposed) and metformin nonusers (unexposed). The primary outcome measured was inhospital mortality.
  
  
  RESULTS
  The study included 44 metformin users and 118 nonusers. Metformin users were similar to nonusers with respect to levels of lactate, HCO3, and blood pH; however, they were older and had higher incidence rates of cardiovascular disease and acute kidney injury at admission, compared to nonusers. Inhospital mortality rates were significantly lower in the metformin-treated group, 56.8 % vs. 88.1 %, p <0.0001.
  
  
  CONCLUSIONS
  Though high lactate concentration indicates poor prognosis in septic patients, mortality rate was found to be significantly lower in those who were treated with metformin. This finding may help clinicians in deciding treatment for these patients, who could otherwise be considered too ill for real treatment benefit.
authors.affiliation: Department of Nephrology, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, 70300, Israel. kerendoenyas@gmail.com.|Research and Development Unit, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, 70300, Israel. kerendoenyas@gmail.com.
authors.forename: Keren
authors.initials: K
authors.lastname: Doenyas-Barak
authors.affiliation: Department of Nephrology, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, 70300, Israel.
authors.forename: Ilia
authors.initials: I
authors.lastname: Beberashvili
authors.affiliation: Internal Medicine C Department, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, 70300, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Marcus
authors.affiliation: Department of Nephrology, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, 70300, Israel.|Research and Development Unit, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, 70300, Israel.|Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 69978, Israel.
authors.forename: Shai
authors.initials: S
authors.lastname: Efrati
mesh_terms: D000140:Acidosis, Lactic / Q000188:drug therapy* / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000009:adverse effects* / Q000627:therapeutic use*; D008875:Middle Aged; D011379:Prognosis; D012772:Shock, Septic
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin