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Serum lactate level and mortality in metformin-associated lactic acidosis requiring renal replacement therapy: a systematic review of case reports and case series

机译：血清乳酸水平和二甲双胍相关乳酸中毒中的死亡率，需要肾置换疗法：案件报告和案例系列的系统审查

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Abstract Background The current practice concerning timing, mode, and dose of renal replacement therapy (RRT) in patients with metformin-associated lactic acidosis (MALA) with renal failure remains unknown. To investigate whether serum lactate level and prescription pattern of RRT are associated with mortality in patients with MALA requiring RRT. Methods We searched PubMed/Medline and EMBASE from inception to Sep 2014 and applied predetermined exclusion criteria. Case-level data including case’s demographics and clinical information related to MALA were abstracted. Multiple logistic regression modeling was used to examine the predictors of mortality. Results A total of 253 unique cases were identified with cumulative mortality of 17.2%. Eighty-seven percent of patients had acute kidney injury. Serum lactate level was significantly higher in non-survivors (median 22.5 mmol/L) than in survivors (17.0 mmol/L, p-value <0.01) and so did the median blood metformin concentrations (58.5 vs. 43.9 mg/L, p-value = 0.05). The survival advantage was not significantly different between the modalities of RRT. The adjusted odds ratio of mortality for every one mmol/L increase in serum lactate level was 1.09 (95% CI 1.02–1.17, p-value = 0.01). The dose-response curve indicated a lactate threshold greater than 20 mmol/L was significantly associated with mortality. Conclusions Our study suggests that predialysis level of serum lactate level is an important marker of mortality in MALA patients requiring RRT with a linear dose-response relationship. To better evaluate the optimal prescription of RRT in MALA, we recommend fostering an international consortium to support prospective research and large-scale standardized case collection.
机译：摘要背景肾置乳酸中毒（MALA）肾脏替代治疗（rrt）的当前实践，肾脏替代疗法（rrt）肾功能衰竭仍然未知。研究RRT的血清乳酸水平和处方模式是否与MALA患者需要RRT的死亡率有关。方法我们搜索了PubMed / Medline，并从2004年9月开始撤销并施加预定排除标准。案例级数据包括案例的人口统计数据和与MALA相关的临床信息被抽象出来。多个逻辑回归建模用于检查死亡率的预测因子。结果累积253例独特的案例，累积死亡率为17.2％。八十七名患者患有急性肾损伤。非幸存者（中位数22.5mmol / L）血清乳酸水平显着高于幸存者（17.0mmol / L，p值<0.01），因此中位血液二甲双胍浓度（58.5与43.9 mg / L，p -Value = 0.05）。在RRT的方式之间存在存活优势在显着差异。每一个mmol / l血清乳酸水平的每一个mmol / l增加的调整后的差率比为1.09（95％CI 1.02-1.17，p值= 0.01）。剂量 - 响应曲线表示大于20mmol / L的乳酸阈值与死亡率显着相关。结论我们的研究表明，血清乳酸水平的预析性水平是需要具有线性剂量反应关系的MALA患者死亡率的重要标志。为了更好地评估MALA中RRT的最佳处方，建议促进促进国际财团，以支持预期研究和大规模标准化案例收集。

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