Outcome of Metformin-associated Lactic Acidosis in Type 2 Diabetic Patients
摘要
Lactic acidosis is a rare but life-threatening complication of metformin treatment. The current contraindications to metformin use have been defined for prevention of this adverse event; renal dysfunction is among the most important ones. This study aimed to explore the factors associated with unfavorable outcome of metformin-associated lactic acidosis (MALA) and assess the impact of previous chronic kidney disease (CKD). We conducted a retrospective analysis of patients admitted in ICU with MALA during a five-year period. The premorbid conditions, clinical presentations, biological data, therapeutic strategies and outcomes were recorded. A total of 17 patients with MALA were identified. All of them were accompanied by acute kidney injury and associated with a mortality rate of 35.3%. The factors associated with a fatal outcome were high APACHE (acute physiology and chronic health evaluation) II score (p=0.002), the presence of shock (p=0.028), the requirement for mechanical ventilation (p=0.002) and vasopressors (p=0.035). Compared with non-survivors, the survivors stayed longer in the ICU (p=0.014). There were no significant differences on illness severity and mortality rate between patients with or without previous CKD. In conclusion, the prognosis of MALA is mainly determined by the severity of underlying conditions. Previous stage 3 CKD has no negative influence on the outcome following acute kidney injury.