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Increased Mortality Associated with Hypermagnesemia in Severe COVID-19 Illness
Jacob S Stevens1,2, Andrew A Moses1, Thomas L Nickolas1,2
1Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Insights
Hypermagnesemia, or high magnesium levels, was found in 21% of hospitalized COVID-19 patients. This condition was linked to a doubled risk of mortality and more severe illness.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Electrolyte abnormalities are common in COVID-19 patients.
- Magnesium homeostasis in COVID-19 has been underreported.
- This study investigates hypermagnesemia incidence and outcomes in COVID-19.
Purpose of the Study:
- To determine the incidence of hypermagnesemia in hospitalized COVID-19 patients.
- To assess the association between hypermagnesemia and clinical outcomes.
- To explore factors associated with hypermagnesemia in this cohort.
Main Methods:
- Retrospective analysis of 1685 COVID-19 patients admitted to a New York City hospital.
- Hypermagnesemia defined as median magnesium >2.4 mg/dl during hospitalization.
- Data collected on demographics, hospital course, and laboratory values.
Main Results:
- 21% of patients (355/1685) had hypermagnesemia.
- Hypermagnesemia associated with higher rates of shock, respiratory failure, and acute kidney injury (AKI).
- Hypermagnesemia linked to increased 30-day mortality (34% vs 65%) and higher risk of death (HR 2.03).
Conclusions:
- Hypermagnesemia is associated with increased mortality in hospitalized COVID-19 patients.
- Potential mechanisms include increased cell turnover and severity of illness, often linked to AKI.
- Further research is needed to clarify the exact relationship and underlying mechanisms.
Background:
Although electrolyte abnormalities are common among patients with COVID-19, very little has been reported on magnesium homeostasis in these patients. Here we report the incidence of hypermagnesemia, and its association with outcomes among patients admitted with COVID-19.
Methods:
We retrospectively identified all patients with a positive test result for SARS-CoV-2 who were admitted to a large quaternary care center in New York City in spring 2020. Details of the patients' demographics and hospital course were obtained retrospectively from medical records. Patients were defined as having hypermagnesemia if their median magnesium over the course of their hospitalization was >2.4 mg/dl.
Results:
A total of 1685 patients hospitalized with COVID-19 had their magnesium levels checked during their hospitalization, and were included in the final study cohort, among whom 355 (21%) had hypermagnesemia. Patients who were hypermagnesemic had a higher incidence of shock requiring pressors (35% vs 27%, P<0.01), respiratory failure requiring mechanical ventilation (28% vs 21%, P=0.01), AKI (65% vs 50%, P<0.001), and AKI severe enough to require renal replacement therapy (18% vs 5%, P<0.001). In an adjusted multivariable model, hypermagnesemia was observed more commonly with increasing age, male sex, AKI requiring RRT, hyperkalemia, and higher CPK. Survival probability at 30 days was 34% for the patients with hypermagnesemia, compared with 65% for patients without hypermagnesemia. An adjusted multivariable time to event analysis identified an increased risk of mortality with older age, need for vasopressors, higher C-reactive protein levels, and hypermagnesemia (HR, 2.03; 95% CI, 1.63 to 2.54, P<0.001).
Conclusions:
In conclusion, we identified an association between hypermagnesemia among patients hospitalized with COVID-19 and increased mortality. Although the exact mechanism of this relationship remains unclear, hypermagnesemia potentially represents increased cell turnover and higher severity of illness, which is frequently associated with more severe forms of AKI.
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