Prognosis of extremely severe lactic acidosis in metformin-treated patients with septic shock: continuous (?) renal replacement therapy in the spotlight!

Excerpt

We read with interest the recent paper by Doenyas-Barak et al. [1] comparing the prognosis of extremely elevated plasma lactate levels between metformin (MET)-treated and MET-naive patients with septic shock. The most remarkable finding was a highly significant lower in-hospital mortality (56.8 vs. 88.1 %, p < 0.0001) in MET users despite a more explicit risk profile (diabetes, older age) and greater baseline disease severity (higher incidences of cardiovascular disease, acute kidney injury, and underlying malignancy) [1]. The authors briefly elaborate on this unexpected survival benefit by pointing out some potential protective MET-related anti-inflammatory, anti-thrombotic, and cellular effects. However, we believe that the observed difference in mortality rate is most likely due to the more frequent use of renal replacement therapy (RRT) in the MET-treated population (38.6 vs. 21.2 %, p = 0.13). …