Association of preadmission metformin use and prognosis in patients with sepsis with diabetes: a systematic review and meta-analysis - Report - MDSpire
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Association of preadmission metformin use and prognosis in patients with sepsis with diabetes: a systematic review and meta-analysis
Impact of Prior Metformin Use on Mortality in Diabetic Sepsis Patients
Overview
This systematic review and meta-analysis of 14 cohort studies involving 12,687 diabetic sepsis patients found that preadmission metformin use is associated with significantly reduced overall mortality, including 28-day, 90-day, 365-day, and in-hospital mortality. Additionally, metformin use correlated with improved serum creatinine levels but elevated serum lactate.
Background
Sepsis is a leading cause of mortality worldwide, with diabetic patients at increased risk due to immune dysfunction and chronic inflammation. Metformin, a widely used first-line agent for type 2 diabetes, has anti-inflammatory and immunomodulatory effects that may confer protective benefits in sepsis. However, existing studies on metformin's impact on sepsis outcomes in diabetic patients have yielded conflicting results, necessitating a comprehensive synthesis of evidence.
Data Highlights
Outcome
Odds Ratio (OR)
95% Confidence Interval (CI)
P-value
Significance
Overall Mortality
0.58
0.44–0.75
<0.00001
Significant
28-day Mortality
0.61
Not specified
0.002
Significant
90-day Mortality
0.48
Not specified
0.001
Significant
365-day Mortality
0.33
Not specified
0.0005
Significant
In-hospital Mortality
0.43
Not specified
<0.02
Significant
30-day Mortality
0.71
Not specified
0.06
Not Significant
60-day Mortality
0.72
Not specified
0.22
Not Significant
ICU Mortality
0.76
Not specified
0.25
Not Significant
Serum Creatinine (Mean Difference)
-0.32
Not specified
0.04
Significant
Key Findings
Preadmission metformin use significantly reduces overall mortality in diabetic sepsis patients (OR 0.58, P < 0.00001).
Significant mortality reductions were observed at 28-day, 90-day, 365-day, and in-hospital time points.
No significant mortality benefit was found at 30-day, 60-day, or ICU mortality endpoints.
Metformin use is associated with improved renal function as evidenced by decreased serum creatinine (MD −0.32, P = 0.04).
Metformin users exhibited elevated serum lactate levels, though clinical implications require further study.
All included studies had low risk of bias, strengthening the validity of findings.
Clinical Implications
Clinicians should consider preadmission metformin use as a favorable prognostic factor in diabetic patients presenting with sepsis. These findings support incorporating metformin history into sepsis management protocols and may inform antimicrobial stewardship and sepsis bundle strategies. Further randomized controlled trials are warranted to confirm metformin’s protective effects and elucidate mechanisms.
Conclusion
This meta-analysis demonstrates that preadmission metformin use is associated with reduced mortality and improved renal function in diabetic sepsis patients, highlighting its potential as a beneficial adjunct in sepsis management. Integration of metformin history into clinical guidelines could enhance prognostication and treatment strategies.
References
Yang et al. 2025 -- Impact of Prior Metformin Administration on Outcomes in Diabetic Patients with Sepsis: A Systematic Review and Meta-Analysis
