Metformin use in patients hospitalized with COVID-19: lower inflammation, oxidative stress, and thrombotic risk markers and better clinical outcomes
Usman et al.
, Metformin use in patients hospitalized with COVID-19: lower inflammation, oxidative stress, and thrombotic..
, Journal of Thrombosis and Thrombolysis, doi:10.1007/s11239-022-02631-7
Retrospective 75 diabetes patients, 34 on metformin, showing improved clinical outcomes with treatment, without statistical significance.
risk of death, 59.8% lower, RR 0.40, p = 0.21, treatment 3 of 34 (8.8%), control 9 of 41 (22.0%), NNT 7.6.
risk of mechanical ventilation, 75.9% lower, RR 0.24, p = 0.05, treatment 2 of 34 (5.9%), control 10 of 41 (24.4%), NNT 5.4.
hospitalization time, 33.7% lower, relative time 0.66, p = 0.13, treatment 34, control 41.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Usman et al., 18 Jan 2022, retrospective, USA, peer-reviewed, 10 authors.
Abstract: Journal of Thrombosis and Thrombolysis
Metformin use in patients hospitalized with COVID‑19: lower
inflammation, oxidative stress, and thrombotic risk markers and better
Abira Usman1 · Kevin P. Bliden1 · Alastair Cho1 · Naval Walia1 · Christophe Jerjian1 · Arvind Singh1 ·
Parshotam Kundan1 · Sanchit Duhan1 · Udaya S. Tantry1 · Paul A. Gurbel1
Accepted: 30 December 2021
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022
Diabetes mellitus (DM) is associated with a greater risk of COVID-19 and an increased mortality when the disease is contracted. Metformin use in patients with DM is associated with less COVID-19-related mortality, but the underlying mechanism behind this association remains unclear. Our aim was to explore the effects of metformin on markers of inflammation,
oxidative stress, and hypercoagulability, and on clinical outcomes. Patients with DM on metformin (n = 34) and metformin
naïve (n = 41), and patients without DM (n = 73) were enrolled within 48 h of hospital admission for COVID-19. Patients on
metformin compared to naïve patients had a lower white blood cell count (p = 0.02), d-dimer (p = 0.04), urinary 11-dehydro
thromboxane B2 (p = 0.01) and urinary liver-type fatty acid binding protein (p = 0.03) levels and had lower sequential organ
failure assessment score (p = 0.002), and intubation rate (p = 0.03), fewer hospitalized days (p = 0.13), lower in-hospital
mortality (p = 0.12) and lower mortality plus nonfatal thrombotic event occurrences (p = 0.10). Patients on metformin had
similar clinical outcomes compared to patients without DM. In a multiple regression analysis, metformin use was associated
with less days in hospital and lower intubation rate. In conclusion, metformin treatment in COVID-19 patients with DM was
associated with lower markers of inflammation, renal ischemia, and thrombosis, and fewer hospitalized days and intubation
requirement. Further focused studies are required to support these findings.
Keywords COVID-19 · Diabetes · Metformin · Thromboelastography · Biomarker · Death · Intubation
• Fasting blood glucose level in patients with COVID-19
has been shown to be associated with severity of the disease and poor outcomes, including mortality.
• Metformin use in patients with DM is associated with
less COVID-19-related mortality, but the underlying
mechanism behind this association remains unclear.
• In this single center study, metformin treatment in
COVID-19 patients with DM was associated with lower
* Paul A. Gurbel
Sinai Center for Thrombosis Research and Drug
Development, Sinai Hospital of Baltimore, Lifebridge
Health, Baltimore, MD 21215, USA
markers of inflammation, renal ischemia, and thrombosis,
and fewer hospitalized days and intubation requirement.
• In a multiple regression analysis, metformin use was
associated with less days in hospital and lower intubation rate.
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