LAUSR

AIM To compare the risks of all-cause mortality, hepatic outcomes, major adverse cardiovascular events between metformin users and non-users for patients with diabetes and cirrhosis. METHODS From the Taiwan's National Health Insurance Research Database (NHIRD), we selected propensity-score matched metformin users and non-users from the cohorts of type 2 diabetes mellitus (T2DM) with compensated (n = 26164) or decompensated liver cirrhosis (n = 15056) between January 1, 2000, and December 31, 2009, and followed them through until December 31, 2010. Cox proportional hazards models with robust sandwich standard error estimates were used to assess risk of investigated outcomes for metformin users. RESULTS The incidence rates of mortality during follow-up were 3.8 and 3.3 per 100 patient-years (adjusted hazard ratio [aHR] 1.13, 95% CI 1.01-1.25) for metformin users and non-users, respectively. The incidence rates of cirrhotic decompensation during follow-up were 5.9 and 4.9 per 100 patient-years (aHR 1.15, 95% CI 1.04-1.27) for metformin users and non-users. The risk of death (p for trend<0.01) and cirrhotic decompensation (p for trend <0.0001) associated with metformin use was significant for those taking metformin for > 40 defined daily dose (DDD) in 90 days or >1000 mg/day. The outcomes of metformin use vs nonuse for T2DM with decompensated liver cirrhosis were not statistically different, except that metformin users had higher risk of mortality (aHR 1.15). CONCLUSION Metformin use was associated with higher risks of mortality and cirrhotic decompensation in patients with compensated liver cirrhosis. Prospective studies are required to confirm our results.