BACKGROUND The safety and efficacy of sodium–glucose cotransporter 2 (SGLT2) inhibitors in hospitalized patients are unclear. PURPOSE To evaluate outcomes of inpatient SGLT2 inhibitor use. DATA SOURCES MEDLINE, Embase, Emcare, and Cochrane databases were searched through 29 May 2024. STUDY SELECTION Randomized controlled trials (RCTs) and observational cohort studies with assessment of SGLT2 inhibitor use in patients hospitalized for any reason were included. DATA EXTRACTION Study characteristics and clinical outcomes were extracted. DATA SYNTHESIS We performed a random-effects meta-analysis analyzing RCTs and cohort studies separately. Heterogeneity was quantified with the I2 statistic. Twenty-three RCTs comprising 19,846 participants (29.5% with type 2 diabetes) with comparison of SGLT2 inhibitors with placebo or active comparator were included. Ketoacidosis rates were 0.210 per 100 person-years (95% CI 0.119, 0.370) for SGLT2 inhibitors and 0.140 per 100 person-years (95% CI 0.070, 0.280) for control (rate ratio 1.50 [95 CI 0.56, 4.23], P = 0.38). SGLT2 inhibitor use was associated with fewer readmissions and urgent visits (odds ratio [OR] 0.64 [95 CI 0.47, 0.86], P < 0.01) and lower mortality rates (OR 0.74 [95% CI 0.56, 0.98], P = 0.03) in heart failure trials and lower incidence of acute kidney injury (OR 0.76 [95% CI 0.60, 0.97], P = 0.03) among all RCTs. Twenty observational studies were included and did not show increased adverse events. LIMITATIONS Ketoacidosis rates were low, likely leading to lack of power to detect significant differences. CONCLUSIONS SGLT2 inhibitor use among hospitalized patients was associated with numerically higher rates of ketoacidosis, although further studies are required.

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关于住院患者使用钠-葡萄糖协同转运蛋白 2 抑制剂的安全性和有效性的系统评价和荟萃分析


背景钠-葡萄糖协同转运蛋白 2 （SGLT2） 抑制剂在住院患者中的安全性和有效性尚不清楚。目的 评估住院患者 SGLT2 抑制剂使用的结果。数据来源 截至 2024 年 5 月 29 日，检索了 MEDLINE、EMBASE、EMCARE 和 Cochrane 数据库。研究选择 纳入随机对照试验 （RCT） 和观察性队列研究，评估因任何原因住院的患者使用 SGLT2 抑制剂。资料提取 提取研究特征和临床结局。数据综合 我们进行了一项随机效应荟萃分析，分别分析了 RCT 和队列研究。异质性用 I2 统计量量化。纳入了 23 项随机对照试验，涉及 19,846 名参与者 （29.5% 患有 2 型糖尿病），并将 SGLT2 抑制剂与安慰剂或活性对照剂进行比较。SGLT2 抑制剂的酮症酸中毒发生率为 0.210/100 人年 （95% CI 0.119， 0.370），对照组为 0.140/100 人年 （95% CI 0.070， 0.280） （率比 1.50 [95 CI 0.56， 4.23]，P = 0.38）。在心力衰竭试验中，SGLT2 抑制剂的使用与较低的再入院率和紧急就诊率 （比值比 [OR] 0.64 [95% CI 0.47， 0.86]，P < 0.01） 和较低的死亡率 （OR 0.74 [95% CI 0.56， 0.98]，P = 0.03） 和较低的急性肾损伤发生率 （OR 0.76 [95% CI 0.60， 0.97]，P = 0.03） 相关。纳入了 20 项观察性研究，未显示不良事件增加。局限性 酮症酸中毒发生率低，可能导致缺乏检测显著差异的能力。结论 住院患者使用 SGLT2 抑制剂与酮症酸中毒的发病率较高相关，但需要进一步研究。