The Effect of Metformin Consumption on Mortality in Hospitalized COVID-19 patients: a systematic review and meta-analysis
Antonia Anna Lukito, Raymond Pranata, Joshua Henrina, Michael Anthonius Lim, Sherly Lawrensia, Ketut Suastika
Diabetes & Metabolic Syndrome: Clinical Research & Reviews, doi:10.1016/j.dsx.2020.11.006
Background and aims: Diabetes is one of the most common comorbidities, and it is associated with poorer outcomes in patients with coronavirus disease 2019 . Preliminary findings showed that mortality was reduced in those who consume metformin compared to those who did not, and given its low cost and widespread availability; metformin is an attractive and potential agent to mitigate excessive risk in diabetic populations. Methods: Several medical databases (Pubmed, EuropePMC, EBSCOhost, Proquest, Cochrane library) and two health-science preprint servers (preprint.org and Medrxiv) were systematically searched for relevant literature. Results: Nine studies with 10,233 subjects were included in the qualitative and quantitative synthesis. Meta-analysis showed that metformin is associated with lower mortality in pooled non-adjusted model (OR 0.45 [0.25, 0.81], p ¼ 0.008; I 2: 63.9%, p ¼ 0.026) and pooled adjusted model (OR 0.64 [0.43, 0.97], p ¼ 0.035; I 2 : 52.1%, p ¼ 0.064).
Conclusion: The analysis showed that metformin consumption was associated with lower mortality. Randomized controlled trials are needed to confirm this finding.
Ethics approval and consent to participate Not Applicable.
Consent for publication Not Applicable.
Conflicts of interest The authors declare that they have no competing interests.
Abbreviations
ACE2 Angiotensin
References
Abu-Jamous, Anisimovich, Baxter, Mackillop, Vizcaychipi et al., Associations of comorbidities and medications with COVID-19 outcome: a retrospective analysis of real-world evidence data,
doi:10.1101/2020.08.20.20174169Bertrand, Samy, Matthieu, Al-Salameh, Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study, Diabetologia,
doi:10.1007/s00125-020-05180-xBramante, Ingraham, Murray, Marmor, Hoversten et al., Observational study of metformin and risk of mortality in patients hospitalized with covid-19, MedRxiv Prepr Serv Heal Sci,
doi:10.1101/2020.06.19.20135095Chen, Yang, Cheng, Chen, Peng et al., Clinical characteristics and outcomes of patients with diabetes and COVID-19 in association with glucose-lowering medication, Diabetes Care,
doi:10.2337/dc20-0660Cheng, Liu, Li, Zhang, Lei et al., Metformin is associated with higher incidence of acidosis, but not mortality, in individuals with COVID-19 and pre-existing type 2 diabetes, Cell Metab
Cochrance, Review manager (RevMan
Crouse, Grimes, Li, Might, Ovalle et al., Metformin use IS associated with reduced mortality IN a diverse population with COVID-19 and diabetes, MedRxiv Prepr Serv Heal Sci,
doi:10.1101/2020.07.29.20164020El-Arabey, Abdalla, Metformin and COVID-19: a novel deal of an old drug, J Med Virol,
doi:10.1002/jmv.25958Guan, Ni, Hu, Liang, Ou et al., Clinical characteristics of coronavirus disease 2019 in China, N Engl J Med,
doi:10.1056/NEJMoa2002032Huang, Lim, Pranata, Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia e a systematic review, meta-analysis, and meta-regression: diabetes and COVID-19, Diabetes Metab Syndr Clin Res Rev,
doi:10.1016/j.dsx.2020.04.018Huang, Pranata, Lim, Oehadian, Alisjahbana, C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis, Ther Adv Respir Dis,
doi:10.1177/1753466620937175Kim, Jeon, Kim, Moon, Cho et al., The clinical characteristics and outcomes of patients with moderate-to-severe coronavirus disease 2019 infection and diabetes in daegu, South Korea, Diabetes Metab J,
doi:10.4093/dmj.2020.0146Li, Guan, Wu, Wang, Zhou et al., Early transmission dynamics in wuhan, China, of novel coronaviruseinfected pneumonia, N Engl J Med,
doi:10.1056/NEJMoa2001316Lim, Huang, Yonas, Vania, Pranata, A wave of non-communicable diseases following the COVID-19 pandemic, Diabetes Metab Syndr Clin Res Rev,
doi:10.1016/j.dsx.2020.06.050Lim, Pranata, Coronavirus disease 2019 (COVID-19) markedly increased mortality in patients with hip fracture e a systematic review and metaanalysis, J Clin Orthop Trauma,
doi:10.1016/j.jcot.2020.09.015Lim, Pranata, Huang, Yonas, Soeroto et al., Multiorgan failure with emphasis on acute kidney injury and severity of COVID-19: systematic review and meta-analysis, Can J Kidney Heal Dis,
doi:10.1177/2054358120938573Luo, Qiu, Liu, Liu, Zheng et al., Metformin treatment was associated with decreased mortality in COVID-19 patients with diabetes in a retrospective analysis, Am J Trop Med Hyg,
doi:10.4269/ajtmh.20-0375Philipose, Smati, Wong, Aspey, Mendall, Obesity, old age and frailty are the true risk factors for COVID-19 mortality and not chronic disease or ethnicity in Croydon, MedRxiv,
doi:10.1101/2020.08.12.20156257Pranata, Huang, Lim, Wahjoepramono, July, Impact of cerebrovascular and cardiovascular diseases on mortality and severity of COVID-19 -systematic review, meta-analysis, and meta-regression, J Stroke Cerebrovasc Dis,
doi:10.1016/j.jstrokecerebrovasdis.2020.104949Pranata, Lim, Huang, Raharjo, Lukito, Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: a systematic review, meta-analysis and meta-regression, JRAAS -J Renin-Angiotensin-Aldosterone Syst,
doi:10.1177/14703203209268Pranata, Lim, Yonas, Siswanto, Meyer, Out-of-hospital cardiac arrest prognosis during the COVID-19 pandemic, Intern Emerg Med,
doi:10.1007/s11739-020-02428-7Pranata, Lim, Yonas, Vania, Lukito et al., Body mass index and outcome in patients with COVID-19: a dose-response meta-analysis, Diabetes Metab,
doi:10.1016/j.diabet.2020.07.005Pranata, Permana, Huang, Lim, Soetedjo et al., The use of renin angiotensin system inhibitor on mortality in patients with coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis, Diabetes Metab Syndr Clin Res Rev,
doi:10.1016/j.dsx.2020.06.047Pranata, Soeroto, Huang, Lim, Santoso, Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19, Int J Tubercul Lung Dis,
doi:10.5588/ijtld.20.0278Pranata, Tondas, Huang, Lim, Siswanto et al., Potential role of telemedicine in solving ST-segment elevation dilemmas in remote areas during the COVID-19 pandemic, Am J Emerg Med,
doi:10.1016/j.ajem.2020.06.012Yang, Lin, Ji, Guo, Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes, Acta Diabetol,
doi:10.1007/s00592-009-0109-4Yonas, Alwi, Pranata, Huang, Lim et al., Effect of heart failure on the outcome of COVID-19 -a meta analysis and systematic review, Am J Emerg Med,
doi:10.1016/j.ajem.2020.07.009Zhu, Zhang, Li, Yang, Song, A novel coronavirus from patients with pneumonia in China, 2019, N Engl J Med,
doi:10.1056/NEJMoa2001017
