title: Impact of Metformin Use on Lactate Kinetics in Patients with Severe Sepsis and Septic Shock.
abstract: We aimed to evaluate the impact of metformin use on lactate kinetics in patients with severe sepsis and septic shock.
  
  
  
  We analyzed data from a registry that included patients who presented to the emergency department and met criteria for severe sepsis or septic shock. Patients were divided into two groups based on metformin use. We compared lactate concentrations, lactate clearance (LC), and normalization at 6 h (H6) and 24 h (H24) after the initial (H0) measurement. Propensity score matching, multiple logistic, and linear regression analysis via a generalized estimating equations method were used.
  
  
  
  Of 1,318 patients, 71 patients were in the metformin use group and all 71 were selected in a one to two propensity matching. Metformin users showed significantly higher lactate levels at H0 (5.3 vs. 4.4 mmol/L) and H6 (3.8 vs. 2.9 mmol/L) in all patients, although in the matched subset, the effect was marginal (H0, 5.3 vs. 4.9 mmol/L; H6, 3.8 vs. 3.2 mmol/L; H24, 2.7 vs. 2.4 mmol/L). Mean LC (H6, 29% vs. 34%; H24, 43% vs. 49%) and normalization rate (H6, 27% vs. 28%; H24, 49% vs. 52%) were also not significantly different. Although metformin use appeared to be associated with higher lactate levels before using the propensity score method, no significant association was found between metformin use and lactate kinetics variables in the balanced matched subset data.
  
  
  
  Lactate levels in metformin users were initially elevated in the early phase of resuscitation from severe sepsis and septic shock. However, there was no significant difference in lactate levels, LC, and normalization over the initial 24 h period based on metformin use.
authors: *Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea †Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea ‡Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea §Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea ||Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea ¶Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada.
authors: Joongmin
authors: J
authors: Park
authors: Sung Yeon
authors: SY
authors: Hwang
authors: Ik Joon
authors: IJ
authors: Jo
authors: Kyeongman
authors: K
authors: Jeon
authors: Gee Young
authors: GY
authors: Suh
authors: Tae Rim
authors: TR
authors: Lee
authors: Hee
authors: H
authors: Yoon
authors: Won Chul
authors: WC
authors: Cha
authors: Min Seob
authors: MS
authors: Sim
authors: Keumhee Chough
authors: KC
authors: Carriere
authors: Seungmin
authors: S
authors: Yeon
authors: Tae Gun
authors: TG
authors: Shin
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood*; D012772:Shock, Septic / Q000097:blood*
chemical_list: D019344:Lactic Acid; D008687:Metformin