Work

Correlation between metformin use and mortality in acute respiratory failure: a retrospective ICU cohort study

Year: 2025

Type: article

Abstract: Background: The aim of this study was to investigate the association of metformin use with the risk of in-hospital mortality and prognosis in acute respiratory failure (ARF) patients admitted to the intensive care unit (ICU). Methods: We conducted a retrospective cohort study using the MIMIC-IV database. Patients were categorized into metformin and non-metformin groups based on medication exposure. Primary outcomes were in-hospital and ICU mortality, while 30-day and 90-day all-cause mortality served as secondary endpoints. We applied Kaplan-Meier survival curves, Cox proportional hazards models, and logistic regression to assess associations. Propensity score matching (PSM) and machine learning algorithms were used for confounder adjustment and feature selection. Results: After PSM, 1,429 patients with ARF were included (374 metformin users; 1,055 non-users). Multivariate logistic regression revealed that metformin use was associated with significantly reduced in-hospital mortality (OR = 0.202, 95% CI: 0.123-0.317, p < 0.001) and ICU mortality (OR = 0.245, 95% CI: 0.142-0.399, p < 0.001). Cox models showed consistent reductions in 30-day (HR = 0.199, 95% CI: 0.124-0.320, p < 0.001) and 90-day (HR = 0.230, 95% CI: 0.150-0.352, p < 0.001) mortality. Kaplan-Meier curves confirmed better survival in the metformin group (p < 0.001). Subgroup analyses supported a consistent protective effect of metformin across most patient strata. Conclusion: Metformin use was significantly associated with decreased short-term mortality among ICU patients with ARF. These findings suggest that metformin, beyond its glucose-lowering effects, may offer survival benefits in critically ill populations. Clinicians should consider the potential role of metformin when managing ICU patients with type 2 diabetes and ARF. Further prospective studies are warranted to confirm these findings and optimize clinical application strategies.

Source: Frontiers in Pharmacology

DOI: 10.3389/fphar.2025.1584230

Authors: Yunlin Yang, Jinfeng Liu, Yi Hou, Yuxun Wei, Liang Huang, Wei Wei

Institutions: Sichuan University, West China Second University Hospital of Sichuan University

Language: English

Topic: Respiratory Support and Mechanisms

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801