Incidencia, factores relacionados con la presentación, evolución y mortalidad de la acidosis láctica asociada a metformina en el área sanitaria de un hospital de tercer nivel / Incidence, factors related to presentation, course and mortality of metformin-associated lactic acidosis in the healthcare area of a tertiary hospital

Objetivos: Conocer la incidencia de casos de acidosis láctica por metformina durante el periodo enero de 2014 y marzo de 2017 en el Área Sanitaria III de Aragón. Analizar los factores clínicos y analíticos asociados y la mortalidad. Resultados: Treinta y un casos (61,3% varones). Incidencia: 79,76 casos/100000 pacientes-año; edad media 75,39 ± 9,34 años; 23 de ellos con niveles séricos de metformina (21,91 ± 15,52 mcg / mL); miligramos/día de metformina ingeridos: 1790,32 ± 499; 96,8% de casos en el contexto de fracaso renal agudo; 11 casos con antecedentes de enfermedad renal crónica (35,5%); 12 requirieron UCI (38,7%); 13 requirieron tratamiento depurador (41,9%; 3 hemodiafiltración, 10 hemodiálisis) Existió correlación significativa entre: miligramos diarios ingeridos de metformina y niveles del fármaco; niveles de metformina y: creatinina pico, pH y lactato. La mortalidad fue del 25,8%. Solo hubo diferencias significativas entre los fallecidos y los supervivientes respecto a la duración de la estancia y la creatinina final. La regresión logística multivariante no detectó ninguna variable del estudio asociada con la mortalidad. Conclusiones: La incidencia en nuestra área sanitaria es más elevada que en otras series, con 25,8% de mortalidad. Prácticamente todos los casos en el contexto de fracaso renal agudo de origen prerrenal. En un 29% de los casos hubo sobredosificación. Es necesario advertir a los pacientes de las situaciones más frecuentes potencialmente inductoras de acidosis láctica, especialmente la deshidratación, si siguen tomando el fármaco durante las mismas

Objectives: To determine the incidence of metformin-induced lactic acidosis during the period January 2014 to March 2017 in Aragon Healthcare Area III. To analyse the associated clinical and analytical factors and mortality. Results: A total of 31 cases (61.3% males). Incidence: 79.76 cases/100,000 patients-year; mean age 75.39±9.34 years; 23 of them with levels of serum metformin (21.91 ± 15.52 mcg/ ml); milligrams/day of metformin ingested: 1790.32 ± 499; 96.8% of cases in the context of acute kidney failure; 11 cases with a history of chronic kidney disease (35.5%); 12 required intensive care (38.7%); 13 required purification treatment (41.9%; 3 haemodiafiltration, 10 haemodialysis). There was a significant correlation between daily milligrams of metformin ingested and drug levels; levels of metformin; and peak creatinine, pH and lactate. Mortality was 25.8%. There were only significant differences between the deceased and survivors regarding the duration of stay and final creatinine. Multivariate logistic regression did not detect any study variables associated with mortality. Conclusions: The incidence in our healthcare area is higher than in other series, with a 25.8% mortality rate. Virtually all cases were in the context of prerenal acute kidney failure. In 29% of cases, there was an overdose. Patients must be warned about the most common lactic acidosis-inducing situations, especially dehydration, if they continue taking the drug at such times

Incidence, factors related to presentation, course and mortality of metformin-associated lactic acidosis in the healthcare area of a tertiary hospital. / Incidencia, factores relacionados con la presentación, evolución y mortalidad de la acidosis láctica asociada a metformina en el área sanitaria de un hospital de tercer nivel.

OBJECTIVES: To determine the incidence of metformin-induced lactic acidosis during the period January 2014 to March 2017 in Aragon Healthcare Area III. To analyse the associated clinical and analytical factors and mortality. RESULTS: A total of 31 cases (61.3% males). Incidence: 79.76 cases/100,000 patients-year; mean age 75.39±9.34 years; 23 of them with levels of serum metformin (21.91±15.52 mcg/ ml); milligrams/day of metformin ingested: 1790.32±499; 96.8% of cases in the context of acute kidney failure; 11 cases with a history of chronic kidney disease (35.5%); 12 required intensive care (38.7%); 13 required purification treatment (41.9%; 3 haemodiafiltration, 10 haemodialysis). There was a significant correlation between daily milligrams of metformin ingested and drug levels; levels of metformin; and peak creatinine, pH and lactate. Mortality was 25.8%. There were only significant differences between the deceased and survivors regarding the duration of stay and final creatinine. Multivariate logistic regression did not detect any study variables associated with mortality. CONCLUSIONS: The incidence in our healthcare area is higher than in other series, with a 25.8% mortality rate. Virtually all cases were in the context of prerenal acute kidney failure. In 29% of cases, there was an overdose. Patients must be warned about the most common lactic acidosis-inducing situations, especially dehydration, if they continue taking the drug at such times.