Survival Analysis Of Lactic Acidosis In Hospitalized Patients In Fujian Provincial Hospital

Objective: The main objective of this study was to retrospectively analyze a series of cases of lactic acidosis(LA)patients and clinical variables associated with in-hospital mortality in Fujian Provincial Hospital in recent years.More generally,the study enabled an investigation of the profiles of lactic acidosis patients with type 2 diabetes mellitus(T2DM)and examine its relationship with the use of metformin.Methods: This study included patients admitted to Fujian Provincial Hospital with lactic acidosis(lactic acid ? 5.0 mmol / L,pH ? 7.35)over a 3-year period(from January 1,2013 to December 31,2016).Data extracted included patient demographics,medical history,medications,acute and chronic diseases associated with LA,and relevant laboratory tests.Spearman test was used to analyze the clinical parameters associated with lactate levels.Logistic regression analysis was used to determine the risk factors for in-hospital mortality in patients with lactic acidosis.Results: A total of 168 patients with lactic acidosis were included in this study.Among these,43 patients had T2 DM and 10 patients had taken metformin.All metformin-treated patients had at least 1 additional medical disease(either chronic or acute)associated with an increased risk for LA.More than half(n = 142,84.5%)of the patients with LA died during hospitalization.Spearman test showed that lactate levels were associated with decreased pH(P <0.01,r =-0.359)and bicarbonate(P<0.01,r =-0.464).Logistic regression analysis showed that lactate,bicarbonate,2 diabetes mellitus,acute respiratory failure,acute heart failure and shock were risk factors for in-hospital mortality in patients with lactic acidosis.The in-hospital mortality(50%)in patients with T2 DM treated with metformin was lower than that of T2 DM treated with non-biguanides(78.8%).Conclusion: T2 DM,acute respiratory failure,acute heart failure and shock are important causes of death in patients with lactic acidosis.In patients with LA,approximately 1/4 of the patients with T2 DM were receiving metformin.The in-hospital mortality in patients with T2 DM treated with metformin was lower than that of T2 DM treated with non-biguanides.And all the diabetic patients treated with metformin also suffer from at least one acute or chronic disease associated with an increased risk of lactic acidosis.So it may be overemphasized on metformin for patients with lactic acidosis.