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Background <p>The most prescribed oral glucose-lowering medication worldwide is biguanide (BG), which shows potential for further therapeutic applications. The coronavirus disease 2019 (COVID-19) pandemic is a global public health emergency. Nevertheless, low-cost treatments against COVID-19 have not been established, with varying morbidity and mortality rates in each country.</p> Methods <p>From the inpatient databases in Japan from September 2021 to March 2023, which includes the era following the development of COVID-19 vaccines, we extracted data from 168,370 patients with COVID-19 aged 20– &lt; 80&#xa0;years with diabetes mellitus treated with oral antidiabetic agents. The primary and secondary outcomes were 100-day in-hospital mortality and incidence of acute kidney injury (AKI) during hospitalisation, respectively. We compared outcomes in patients who received BG with those who did not using a logistic regression analysis and Cox proportional hazards under both propensity score-unmatched and matched cohorts.</p> Results <p>The incidence of in-hospital death was significantly lower in the BG group (1.18%) compared with the non-BG group (2.41%) (<i>P</i> &lt; 0.001). Similarly, the incidence of AKI during hospitalisation was significantly lower in the BG group (0.66%) compared to the non-BG group (1.12%) (<i>P</i> &lt; 0.001). Kaplan–Meier analysis from the propensity score-matched cohort showed a significantly better survival rate in the BG group (adjusted HR, 0.619; 95% CI, 0.545–0.702; <i>P</i> &lt; 0.001).</p> Conclusion <p>In patients with COVID-19, oral biguanide use may be associated with reduced in-hospital mortality and AKI risk.</p>

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Biguanides are associated with decreased early mortality and risk of acute kidney injury in hospitalised patients with COVID-19: a nationwide retrospective cohort study in Japan

  • 期刊论文

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  • 发表日期：

    2025年8月27日

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  • Mari Sugimoto,
  • Hiroaki Kikuchi,
  • Eisei Sohara,
  • Koji Mizutani,
  • Kavee Limbutara,
  • Akihiro Hirakawa,
  • Takayasu Mori,
  • Koichiro Susa,
  • Shuichiro Oya,
  • Takefumi Suzuki,
  • Shotaro Naito,
  • Soichiro Iimori,
  • Tatemitsu Rai,
  • Kiyohide Fushimi,
  • Shinichi Uchida

摘要

Background

The most prescribed oral glucose-lowering medication worldwide is biguanide (BG), which shows potential for further therapeutic applications. The coronavirus disease 2019 (COVID-19) pandemic is a global public health emergency. Nevertheless, low-cost treatments against COVID-19 have not been established, with varying morbidity and mortality rates in each country.

Methods

From the inpatient databases in Japan from September 2021 to March 2023, which includes the era following the development of COVID-19 vaccines, we extracted data from 168,370 patients with COVID-19 aged 20– < 80 years with diabetes mellitus treated with oral antidiabetic agents. The primary and secondary outcomes were 100-day in-hospital mortality and incidence of acute kidney injury (AKI) during hospitalisation, respectively. We compared outcomes in patients who received BG with those who did not using a logistic regression analysis and Cox proportional hazards under both propensity score-unmatched and matched cohorts.

Results

The incidence of in-hospital death was significantly lower in the BG group (1.18%) compared with the non-BG group (2.41%) (P < 0.001). Similarly, the incidence of AKI during hospitalisation was significantly lower in the BG group (0.66%) compared to the non-BG group (1.12%) (P < 0.001). Kaplan–Meier analysis from the propensity score-matched cohort showed a significantly better survival rate in the BG group (adjusted HR, 0.619; 95% CI, 0.545–0.702; P < 0.001).

Conclusion

In patients with COVID-19, oral biguanide use may be associated with reduced in-hospital mortality and AKI risk.