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

Abstract

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.

Hypocalcemia in COVID-19 is associated with low vitamin D levels and impaired compensatory PTH response

“…Limitations of this study are: firstly, its retrospective and cross-sectional nature, which did not allow us to evaluate the longitudinal modifications of these biochemical parameters during disease progression and recovery; secondly, the relatively limited number of patients enrolled due to the strict and rigorous inclusion and exclusion criteria used; thirdly, the evaluation of not-corrected tCa levels since albumin levels were not available (although we included ionized calcium levels analysis); and finally, the lack of data on magnesium levels since the latter were sporadically reported to be decreased in COVID-19 patients [ 49 ]. However, it should be noted that hypomagnesemia generally increases PTH secretion and it could hardly explain the impaired compensatory response of PTH observed in COVID-19 patients.…”

The relevance of magnesium homeostasis in COVID-19

“…A retrospective research on a total of 459 confirmed cases found that in the 63 expired individuals magnesium levels on admission were significantly lower than in the 396 survivors (1.61 ± 0.19 vs. 1.81 ± 0.23 mg/dl, respectively) [ 78 ]. Quilliot et al [ 79 ] performed a detailed analysis of magnesemia and associated factors in a cohort of 300 patients. Among these, 48% had a magnesemia below 0.75 mmol/L, including 13% of severely hypomagnesemic patients (0.65 mmol/L) 1 ; on the other hand, a small proportion of patients (9.6%) was hypermagnesemic (> 0.95 mmol/L).…”

“…Despite all limitations, existing data seem to corroborate an association between deranged magnesium homeostasis and COVID-19. The occurrence of hypermagnesemia in ICU cases in the absence of nephropathy, evidenced by two studies [ 79 , 81 ], is an intriguing finding that might be related to rapid mobilization from soft tissues in patients with sepsis or to necrotic events due to microvascular thrombosis. Therefore, this finding may not necessarily be in contrast with data that indicate hypomagnesemia as a risk factor for developing complications.…”

Elements and COVID-19: A Comprehensive Overview of Studies on Their Blood/Urinary Levels and Supplementation with an Update on Clinical Trials

“…Some published studies focused on macroelements in COVID-19 patients revealed alterations in the Mg, Ca, Na, K, and Cl levels. For example, Quilliot et al [ 186 ], who evaluated the prevalence of dysmagnesemia in COVID-19 patients, but not the relationship between magnesemia and patient prognosis, noted a significant decrease in the concentration of Mg in moderately versus critically ill subjects. They also found that hypomagnesemia was significantly higher in patients classified into the moderate group than in critically ill subjects, whereas the prevalence of high-level serum Mg concentrations was markedly elevated in critically ill COVID-19 patients [ 186 ].…”