Admission hypomagnesemia linked to septic shock in patients with systemic inflammatory response syndrome

Abstract

Background: The association between admission serum magnesium (Mg) levels and risk of developing septic shock in patients with systemic inflammatory response syndrome (SIRS) is limited. The aim of this study was to assess the risk of developing septic shock in hospitalized patients with SIRS with various admission Mg levels.

Methods: This is a single-center retrospective study conducted at a tertiary referral hospital. All hospitalized adult patients with SIRS at admission who had admission Mg available from January 2009 to December 2013 were analyzed in this study. Admission Mg was categorized based on its distribution into six groups (<1.5, 1.5-1.7, 1.7-1.9, 1.9-2.1, 2.1-2.3, and >2.3 mg/dL). The primary outcome was septic shock occurring after hospital admission. Logistic regression analysis was performed to obtain the odds ratio (OR) of septic shock of various admission Mg levels using Mg with lowest incidence of shock, 2.1-2.3 mg/dL as the reference group.

Results: Of 2589 patients with SIRS enrolled, septic shock occurred in 236 patients (9.1%). The lowest incidence of septic shock was when serum Mg was within 2.1-2.3 mg/dL. A reverse-checkmark curve emerged demonstrating higher incidences of septic shock associated with both hypoMg (<2.1) and hyperMg (>2.3). After adjusting for potential confounders, hypoMg (<1.5 mg/dL) was associated with an increased risk of developing septic shock with ORs of 1.86 (95% CI 1.07-3.27).

Conclusion: Patients with SIRS and hypoMg (<1.5 mg/dL) at the time of admission had increased risk of developing septic shock during hospitalization.

Keywords: Dysmagnesemia; electrolytes; hypermagnesemia; hypomagnesemia; infection; leukocytosis; magnesium; septic shock; systemic inflammatory response syndrome.