{
  "abstract": "Aims\n\nTo determine whether recorded dipeptidyl peptidase-4 (DPP-4) inhibitor exposure, compared with metformin, is associated with worse hepatic biomarker trajectories or mortality in adults with type 2 diabetes and sepsis.Methods\n\nIn three critical care databases (MIMIC-IV, eICU-CRD, NWICU), adults with type 2 diabetes and sepsis with a DPP-4 inhibitor record were matched 1:3 within each database to metformin comparators on age, sex, body mass index, 24-h SOFA and day-1 estimated glomerular filtration rate. The day 1-7 total bilirubin trajectory was analysed by linear mixed-effects regression under nine specifications including log transformation, flexible day terms, doubly robust adjustment and inverse-probability-of-observation weighting.Results\n\nMatching yielded 105 DPP-4 inhibitor and 297 metformin patients; a pre-admission exposure record was present in 60.0%. The between-group difference in bilirubin slope was +0.048 mg/dL/day (95% CI -0.029 to 0.126; p = 0.221), with p between 0.109 and 0.436 across specifications. No other hepatic outcome survived multiplicity correction. Alkaline phosphatase rose more steeply on the primary specification (+6.97 U/L/day; q = 0.005) but was fragile: 12 of 28 sensitivity analyses retained p < 0.05. In-hospital mortality was 21.0% versus 13.5% (risk ratio 1.56, 95% CI 0.97-2.49), attenuating to 1.23 (0.67-2.29) with documented pre-admission exposure.Conclusions\n\nThere was no statistically detectable difference in bilirubin trajectory between recorded DPP-4 inhibitor and metformin exposure, although differences below the cohort's detectable-effect threshold cannot be excluded. An ALP signal was fragile and hypothesis-generating. Mortality findings are exploratory and non-causal. These associations with recorded exposure cannot inform inpatient management.",
  "abstract_shown": true,
  "affiliations": [
    "Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.",
    "Third Department of Psychiatry, Agioi Anargyroi General Oncological Hospital of Kifisia, National and Kapodistrian University of Athens, Athens, Greece.",
    "BIOSIM Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece.",
    "Department of Electrical and Electronic Engineering, University of West Attica, Thivon Avenue 250, Athens, 122 44, Greece.",
    "Global Business School for Health, University College London, London, WC1E 6BT, UK."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Aristomenis G Alevizopoulos"
    },
    {
      "affs": [
        2
      ],
      "name": "Georgios G Anastasiou"
    },
    {
      "affs": [
        3
      ],
      "name": "Paraskevas Nomikos"
    },
    {
      "affs": [
        4
      ],
      "name": "Iakovos Kritikos"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/64eax4bstb3hg.bib",
  "cited_by": 0,
  "doi": "10.1016/j.metop.2026.100508",
  "fulltext_url": "https://europepmc.org/articles/PMC13678097",
  "id": "64eax4bstb3hg",
  "issns": [
    "2589-9368"
  ],
  "landing_url": "https://europepmc.org/article/MED/42898695",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2712|Diabetes Treatment and Management"
    ]
  ],
  "openalex": "W7221330684",
  "pdf_url": "https://europepmc.org/articles/PMC13678097?pdf=render",
  "pmcid": "PMC13678097",
  "pmid": "42898695",
  "published": "2026-10-10",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/64eax4bstb3hg.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:33Z",
      "native_id": "MED:42898695",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42898695"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Diabetes Treatment and Management",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Hepatic biomarker trajectories and mortality in septic adults with type 2 diabetes and recorded dipeptidyl peptidase-4 inhibitor exposure versus metformin-based therapy: A propensity-score-matched cohort study.",
  "title_text": "Hepatic biomarker trajectories and mortality in septic adults with type 2 diabetes and recorded dipeptidyl peptidase-4 inhibitor exposure versus metformin-based therapy: A propensity-score-matched cohort study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:33Z",
  "url": "https://research.draconitic.com/paper/64eax4bstb3hg",
  "venue": "Metabolism open",
  "versions": []
}