Does Hypomagnesemia Impact on the Outcome of Patients Admitted to the Intensive Care Unit? A Systematic Review and Meta-Analysis

Abstract

Hypomagnesemia is commonly seen but frequently overlooked in critically ill patients in intensive care unit (ICU). However, the strength and consistency of the effect of hypomagnesemia on outcomes in critically ill patients remain controversial. In this report, we performed a systematic review and meta-analysis to evaluate the association of serum magnesium level with prognosis of critically ill patients upon admission to the ICU. A comprehensive search for clinical trials was performed, and 10 studies comprising 1,122 cases and 630 controls were finally selected for analysis. The patients with hypomagnesemia had higher mortality rate (risk ratio [RR] 1.76; 95% confidence interval [CI] 1.54-2.00; P <0.00001), more frequently had sepsis (RR 2.04; 95% CI 1.21-3.42; P = 0.0007) and more frequent need for ventilatory support (RR 1.36; 95% CI 1.21 to 1.53; P <0.00001). Length of ICU stay was also higher in the hypomagnesemia group (RR 1.85; 95% CI 0.43- 3.26; P = 0.01). Collectively, our data indicated that hypomagnesemia appears associated with greater risk of mortality, sepsis, mechanical ventilation, and the length of ICU stay in patients admitted to ICU. The role of magnesium therapy for improving outcomes in critically ill patients is needed to further study.

The impact of tracheotomy timing in critically ill patients undergoing mechanical ventilation: A meta-analysis of randomized controlled clinical trials with trial sequential analysis

“…Otherwise, the random-effects model was selected. 19,20 Sensitivity analysis after excluding one study at a time was performed to assess the stability of the results. Publication bias was determined using a funnel plot and assessed by Egger's test.…”

Evaluation of admission serum magnesium levels in patients with septic shock and its correlation with outcome

“…Jiang Pan et al, 2017 performed a systematic review and meta-analysis to evaluate the association of serum magnesium level with prognosis of critically ill patients upon admission to the ICU. 10,19 studies comprising 1,122 cases and 630 controls were finally selected for analysis. The patients with hypomagnesemia had higher mortality rate (risk ratio [RR] 1.76; 95% Confidence Interval [CI] 1.54-2.00; p<0.00001).…”

The role of magnesium sulfate in the intensive care unit

“…Higher need to mechanical ventilation, increase in the length of mechanical ventilation, increase in the risk of sepsis, higher APACHE score, decrease in NIHS score, decrease in serum albumin level and hypokalemia were also reported in these patients (Jiang et al, 2017[71]; Kumar et al, 2015[85]; Mousavi et al, 2004[109], 2010[110]; Muir and Lees, 1995[112]). MgSO 4 cannot improve the strength of respiratory muscles in the critically ill patients under mechanical ventilation (Johnson et al, 1993[72]).…”

“…These injuries include stroke, aneurysmal subarachnoid hemorrhage (ASAH), and traumatic brain injuries (Afshari et al, 2013[2]; Akdemir et al, 2009[6]; Bradford et al, 2013[18]; Chan et al, 2005[23]; Chen et al, 2015[25]; Chen and Carter, 2011[27]; Dabbagh et al, 2006[30]; Dorhout Mees et al, 2012[33]; Friedlich et al, 2009[42]; Gao et al, 2013[45]; Gonzalez-Garcia et al, 2012[49]; Hassan et al, 2012[58]; James et al, 2009[69]; Jiang et al, 2017[71]; Johnson et al, 1993[72]; Kahraman et al, 2003[75]; Kidwell et al, 2009[79]; Kumar et al, 2015[85]; Lamers et al, 2003[87]; Lampl et al, 2001[88]; Mirrahimi et al, 2015[107]; Mousavi et al, 2004[109], 2010[110]; Muir and Lees, 1995[112]; Muir et al, 2004[113]; Muroi et al, 2008[114]; Rahimi-Bashar et al, 2017[122]; Rinosl et al, 2013[125]; Saver et al, 2015[132]; Selvaraj and Syed, 2014[136]; Singh et al, 2012[144]; Sleeswijk et al, 2008[146]; Stippler et al, 2006[148]; van den Bergh et al, 2005[156]; van Norden et al, 2005[157]; Veyna et al, 2002[158]; Wang et al, 2012[163]; Westermaier et al, 2010[166]; Wong et al, 2010[171]; Zafar et al, 2014[172]; Zhao et al, 2016[174]; Zhu et al, 2004[175]). …”

“…The beneficial effect of MgSO 4 in ICU patients was described and assessed by researchers using different assessment methods (SOFA score, GCS, Rankin score, RASS score, APACHE score, NIH stroke scores, Barthel index, infarction volume, sepsis, tissue oxygenation index, mechanical ventilation and intubation requirement, length of hospital and ICU stay, and mortality) (Afshari et al, 2013[2]; Chen et al, 2015[25]; Dabbagh et al, 2006[30]; Jiang et al, 2017[71]; Kidwell et al, 2009[79]; Kumar et al, 2015[85]; Mousavi et al, 2010[110]; Muir and Lees, 1995[112]; Saver et al, 2015[132]; Singh et al, 2012[144]; Wang et al, 2012[163]; Zafar et al, 2014[172]; Zhao et al, 2016[174]; Zhu et al, 2004[175]).…”