Hyper- and hypomagnesemia as an initial predictor of outcomes in septic pediatric patients in Egypt
1Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.
Insights
Serum magnesium levels in critically ill septic children can be a neglected electrolyte abnormality. While not a sole predictor, hypermagnesemia negatively impacts outcomes, warranting caution in magnesium administration.
Area of Science:
- Pediatric critical care medicine
- Clinical chemistry
- Sepsis research
Background:
- Critically ill septic children often experience electrolyte imbalances, including magnesium disturbances.
- These magnesium abnormalities can be overlooked, potentially affecting patient outcomes.
- This study investigated the relationship between initial serum magnesium levels and outcomes in pediatric sepsis.
Purpose of the Study:
- To determine the correlation between serum magnesium levels on pediatric intensive care unit (PICU) admission and the outcomes of critically ill septic patients.
- To identify predictors of mortality in pediatric sepsis.
Main Methods:
- Prospective study involving 76 children with sepsis from May to November 2023.
- Clinical and laboratory assessments, including initial magnesium levels, were performed.
- Multivariate logistic regression and area under the curve (AUC) analysis were used to identify mortality predictors.
Main Results:
- Median admission magnesium level was 2.0 mg/dl; levels were slightly higher in non-survivors.
- Hypermagnesemia was associated with negative patient outcomes and lower C-reactive protein levels.
- The pediatric Sequential Organ Failure Assessment score (cutoff 5.5) predicted mortality (AUC=0.717).
Conclusions:
- Serum magnesium level alone is insufficient as an initial predictor of mortality.
- Hypermagnesemia negatively impacts critically ill septic children.
- Healthcare professionals should exercise caution when administering magnesium to these patients.
Background:
Critically ill septic children are susceptible to electrolyte abnormalities, including magnesium disturbance, which can easily be neglected. This study examined the potential correlation between serum magnesium levels upon admission to the pediatric intensive care unit (PICU) and the outcomes of critically ill septic patients.
Methods:
This prospective study, conducted from May 2023 to November 2023, included 76 children with sepsis who underwent clinical and lab assessments that included initial magnesium levels. The outcome of sepsis was documented. Predictors of mortality were identified through multivariate logistic regression models, with discrimination and calibration assessed using the area under the curve (AUC).
Results:
The median magnesium level upon PICU admission was 2.0 mg/dl (range 1.1-4.9), and it was slightly higher in non-survivors than survivors (2.1 mg/dl; interquartile range [IQR], 1.9-2.5 vs. 2.0; IQR, 1.8-2.6, respectively), Hypermagnesemia was observed to have a negative effect on critically ill septic patients. It was also found that hypermagnesemia was associated with low C-reactive protein levels (P=0.043). With a cutoff of 5.5, the pediatric Sequential Organ Failure Assessment score strongly predicted mortality (AUC=0.717, P<0.001), with a sensitivity of 64.3% and specificity of 68.8%.
Conclusions:
As an initial predictor of mortality, the serum magnesium level cannot be used alone; however, hypermagnesemia has a negative impact on critically ill septic patients. Thus, healthcare professionals should be cautious with magnesium administration.
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