Determinants of serum magnesium abnormalities and outcome among admissions to the intensive care unit

Laupland, Kevin B.; Tabah, Alexis; Jacobs, Nicole; Ramanan, Mahesh

doi:10.1016/j.accpm.2020.07.020

Cited by 16 publications

(16 citation statements)

References 17 publications

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“…According to K-M survival curve analysis, there was no statistical difference in 28-day mortality, the main endpoint of the study, between the two groups (Fig. 2), which is inconsistent with the previous study on critically ill patients (7) . A retrospective study involving 10 clinical studies has indicated that hypomagnesemia serves as a risk factor for increased mortality in critically ill patients, but it does not exert any effect on the risk of sepsis (8) , which may re ect the particularity and complexity of sepsis patients compared with critically ill patients.…”

Section: Discussioncontrasting

confidence: 86%

Effect of Hypomagnesemia On The Prognosis of Patients With Sepsis in ICU: A Retrospective Cohort Study

et al. 2021

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Objective Existing studies have shown that the incidence of hypomagnesemia may be as high as 60%. However, the correlation between hypomagnesia and sepsis mortality remains elusive. The current study evaluated the effect of hypomagnesemia on the prognosis of patients with sepsis in ICU. Methods It was a retrospective cohort study based on an online database named MIMIC III. A total of 1448 sepsis patients with serum magnesium were admitted to the database, among which 645 patients were screened out. Results At 28 days, 99 patients (30.84%) in the hypomagnesemia group and 123 patients (38.0%) (P = 0.06) in the non-hypomagnesemia group died. There was no correlation between hypomagnesemia and 28-day mortality in patients with sepsis (HR = 1.07; P = 0.87, 95% CI). However, the duration of mechanical ventilation (P < 0.01), the duration of vasoactive drug use (P < 0.01), the length of ICU stay (P < 0.01), and the length of hospital stay (P < 0.01) of patients in the hypomagnesemia group were higher than those in the non-hypomagnesemia group. In the subgroup analysis, the time of no vasopressor (P < 0.01) and the time of no mechanical ventilation (P < 0.01) in the magnesium supplementation group were significantly longer than those in the non-magnesium supplementation group. More importantly, the 14-day mortality (30.8% vs 48.9%, P < 0.01) and 28-day mortality (33.8% vs 48.9%, P = 0.03) in patients with magnesium supplementation were lower than patients without magnesium supplementation. Conclusions For sepsis patients in ICU, although hypomagnesemia had no significant correlation with 28-day mortality, it still prolonged the duration of mechanical ventilation and vasoactive drug use, and increased the length of ICU stay and hospital stay. Even for patients with normal serum magnesium levels, optimizing serum magnesium levels may improve the prognosis of patients with sepsis.

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Section: Discussioncontrasting

confidence: 86%

Effect of Hypomagnesemia On The Prognosis of Patients With Sepsis in ICU: A Retrospective Cohort Study

et al. 2021

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“…Taking into account all the more recent investigations [26] about serum magnesium, 0.65 mmol/L reveals severe deficiency and 0.75 mmol/L the limit of deficiency. According to the recent studies on clinical data [10,18,19], hypermagnesemia was defined by a cutoff equal to or over than 0.95 mmol/L and 1.05 mmol/L.…”

Section: Serum Magnesiummentioning

confidence: 99%

“…Lastly, in a small cohort study [23], hypermagnesemia prevalence was significantly higher in the ICU group than in the outpatient group. Nevertheless, in hospital and ICU, hypermagnesemia could be the strongest independent predictor of mortality and could be associated with a poor prognosis after community-acquired pneumonia [10,18,19]. It commonly occurs due to excessive administration of magnesium salts or magnesium-containing drugs, especially in patients with reduced renal function.…”

Section: Univariate Analysismentioning

confidence: 99%

“…Hypomagnesemia is commonly seen [13][14][15] in intensive care unit (ICU) patients and appears associated with greater risk of mortality, sepsis, mechanical ventilation, and the length of ICU stay [16,17]. In ICU, a retrospective study [18] shows that patients with hypermagnesemia at admission were at two-fold increased crude risk for death than those with normal levels. Lastly, in community-acquired pneumonia, high normal magnesium levels (between 0.82-0.99 mmol/L) have been correlated with higher 30-day mortality rates.…”

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confidence: 99%

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Dysmagnesemia in Covid-19 cohort patients: prevalence and associated factors

Quilliot¹,

Bonsack²,

Jaussaud³

et al. 2020

Magnesium Research

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Hypomagnesemia and hypermagnesemia could have serious implications and possibly lead to progress from a mild form to a severe outcome of Covid-19. Susceptibility of subjects with low magnesium status to develop and enhance this infection is possible. There is little data on the magnesium status of patients with Covid-19 with different degrees of severity. This study was conducted to evaluate prevalence of dysmagnesemia in a prospective Covid-19 cohort study according to the severity of the clinical manifestations and to identify factors associated. Serum magnesium was measured in 300 of 549 patients admitted to the hospital due to severe Covid-19. According to the WHO guidelines, patients were classified as moderate, severe, or critical. 48% patients had a magnesemia below 0.75 mmol/L (defined as magnesium deficiency) including 13% with a marked hypomagnesemia (<0.65 mmol/L). 9.6% had values equal to or higher than 0.95 mmol/L. Serum magnesium concentrations were significantly lower in female than in male (0.73 AE 0.12 vs 0.80 AE 0.13 mmol/L), whereas the sex ratio M/F was higher in severe and critical form (p<0.001). In a bivariate analysis, the risk of magnesium deficiency was significantly and negatively associated with infection severity (p<0.001), sex ratio (M/F, p<0.001), oxygenotherapy (p<0.001), stay in critical care unit (p=0.028), and positively with nephropathy (p=0.026). Logistic regression analysis revealed that the strongest predictors of magnesium deficiency were female sex (OR=2.67, p<0.001) and nephropathy (OR=2.12, p=0.032) and after exclusion of sex ratio, the severity of infection (OR=0.46, p=0.04 and OR=0.39 p=0.01), for critical and moderate forms, respectively. This transversal study reveals a high prevalence of hypomagnesemia in hospitalized patients for Covid-19, while high-level serum magnesium concentration was more prevalent in critical form.

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“…Mg is absorbed in the small intestine and excreted primarily in the kidneys [5]. Mg disorders, including hypomagnesemia and hypermagnesemia, are common electrolyte abnormalities in critically ill patients due to their high severity of illness and the complex therapies provided [6,7]. A recent retrospective cohort study revealed that the prevalence of hypomagnesemia was 23.8% and that the incidence of hypermagnesemia was 11.9% among adult patients admitted to the intensive care unit [7].…”

Section: Introductionmentioning

confidence: 99%

Active Supplementation With Magnesium Sulfate May Be Associated With Worse Prognosis in Sepsis: A Retrospective Analysis of The MIMIC-IV Database

Zhou

Huang

et al. 2021

Preprint

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Background: Magnesium plays pivotal roles in physiological processes. Previous studies have shown that magnesium acts as an important mediator in ameliorating cellular injury and preventing the release of proinflammatory cytokines in septic patients. Therefore, we speculated that the serum magnesium ion level may affect the outcome of sepsis. However, research in this area is rarely reported and it is worth exploring.Methods: We conducted a retrospective study based on the MIMIC-IV database. According to the time-weighted magnesium levels during the ICU stay, we analyzed the relationship between serum magnesium levels and 28-day mortality and 90-day mortality using a time-dependent Cox proportional hazard model and restricted cubic splines. Additionally, we examined the effect of magnesium sulfate supplementation on prognosis with a time-fixed and time-dependent Cox model and restricted cubic splines.Results: In total, 8175 patients were included in this study. Patients with hypo-, normo- and hypermagnesemia were 22.87%, 66.84%, and 10.29%, respectively. When adjusted for confounders, hypermagnesemia was significantly associated with both 28-day mortality (HR=1.42, 95% CI=1.23-1.64, p<0.001) and 90-day mortality (HR=1.42, 95% CI=1.24-1.64, p<0.001). However, no significant difference was found between hypomagnesemia and mortality of septic patients (28-day mortality: HR=1.09, 95% CI=0.86-1.37, p=0.486, 90-day mortality: HR=1.06, 95%=0.85-1.34, p=0.573). For those who received magnesium sulfate supplementation, there was no significant difference among hypo-, normo-, and hypermagnesemia before MgSO4 supplementation. Interestingly, subsequent hypermagnesemia (28-day mortality: HR=1.44, 95% CI=1.17-1.78, p=0.001, 90-day mortality: HR=1.43, 95% CI=1.16-1.77, p=0.001), and even still hypomagnesemia (28-day mortality: HR=1.51, 95% CI=1.15-1.99, p=0.003, 90-day mortality: HR=1.53, 95% CI=1.18-1.99, p=0.001) after MgSO4 supplement were significantly associated with increased 28-day and 90-day mortality after adjustment for confounders.Conclusion: Hypermagnesemia was significantly associated with higher risk of 28-day mortality and 90-day mortality. Active supplementation with magnesium sulfate may be associated with a worse prognosis in sepsis.

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Determinants of serum magnesium abnormalities and outcome among admissions to the intensive care unit

Cited by 16 publications

References 17 publications

Effect of Hypomagnesemia On The Prognosis of Patients With Sepsis in ICU: A Retrospective Cohort Study

Effect of Hypomagnesemia On The Prognosis of Patients With Sepsis in ICU: A Retrospective Cohort Study

Dysmagnesemia in Covid-19 cohort patients: prevalence and associated factors

Active Supplementation With Magnesium Sulfate May Be Associated With Worse Prognosis in Sepsis: A Retrospective Analysis of The MIMIC-IV Database

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