Association between hypomagnesemia and serum lactate levels in patients with sepsis: a retrospective observational study

Springer Science and Business Media LLC
Ken Tonai, Shinshu Katayama, Kansuke Koyama, Hisashi Imahase, Shin Nunomiya

Tóm tắt

Abstract Background Sepsis-3 emphasizes the recognition of sepsis-induced cellular metabolic abnormalities, and utilizes serum lactate level as a biomarker of cellular metabolic abnormalities. Magnesium plays an important role as a cofactor in glucose metabolism, although it is not well known that magnesium deficiency causes elevated serum lactate levels. Additionally, it remains unclear how magnesium status affects the role of serum lactate levels as a marker of metabolic abnormalities in sepsis. Thus, this study aimed to investigate the association between serum magnesium and lactate levels in patients with sepsis and explore this relationship from the perspectives of time course and circulatory abnormalities. Methods This retrospective observational study of adult patients with sepsis was performed at the 16-bed intensive care unit of Jichi Medical University Hospital between June 2011 and December 2017. The relationship between serum magnesium and lactate levels for 5 days from intensive care unit admission was investigated along the time course. Multivariate logistic regression analysis was performed to evaluate the association between serum magnesium and lactate levels during intensive care unit admission. Results Among 759 patients included, 105 had hypomagnesemia (magnesium level < 1.6 mg/dL), 558 had normal serum magnesium levels (1.6–2.4 mg/dL), and 96 had hypermagnesemia (magnesium level > 2.4 mg/dL) at intensive care unit admission. From intensive care unit admission to day 5, the hypomagnesemia group had higher serum lactate levels and a higher frequency of lactic acidosis than the normal magnesium level and hypermagnesemia groups (70% vs. 51.6% vs. 50%; P < 0.001). Hypomagnesemia at intensive care unit admission was independently associated with lactic acidosis, i.e., lactic acid level > 2 mmol/L (odds ratio, 2.76; 95% confidence interval, 1.60–4.76; P < 0.001). Conclusions Hypomagnesemia was associated with serum lactate levels in the early and post-resuscitation phases of sepsis. Further studies are needed to elucidate whether the magnesium status is associated with sepsis-induced cellular and metabolic abnormalities.

Từ khóa


Tài liệu tham khảo

Brooks GA (2018) The science and translation of lactate shuttle theory. Cell Metab 27:757–785

Li X, Yang Y, Zhang B et al (2022) Lactate metabolism in human health and disease. Signal Transduct Target Ther 7:305

Suetrong B, Walley KR (2016) Lactic acidosis in sepsis: it’s not all anaerobic: implications for diagnosis and management. Chest 149:252–261

Vincent JL, Bakker J (2021) Blood lactate levels in sepsis: in 8 questions. Curr Opin Crit Care 27:298–302

Howell MD, Donnino M, Clardy P et al (2007) Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med 33:1892–1899

Gattinoni L, Vasques F, Camporota L et al (2019) Understanding lactatemia in human sepsis. potential impact for early management. Am J Respir Crit Care Med 200:582–589

Singer M, Deutschman CS, Seymour CW et al (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315:801–810

de Baaij JHF, Hoenderop JGJ, Bindels RJM (2015) Magnesium in man: implications for health and disease. Physiol Rev 95:1–46

Jahnen-Dechent W, Ketteler M (2012) Magnesium basics Clin Kidney J 5:i3–i14

Gröber U, Schmidt J, Kisters K (2015) Magnesium in prevention and therapy. Nutrients 7:8199–8226

Pilchova I, Klacanova K, Tatarkova Z et al (2017) The involvement of Mg2+ in regulation of cellular and mitochondrial functions. Oxid Med Cell Longev 2017:6797460

Attaluri P, Castillo A, Edriss H et al (2018) Thiamine deficiency: an important consideration in critically ill patients. Am J Med Sci 356:382–390

Maguire D, Catchpole A, Sheerins O et al (2021) The relation between acute changes in the systemic inflammatory response and circulating thiamine and magnesium concentrations after elective knee arthroplasty. Sci Rep 11:11271

Maguire D, Burns A, Talwar D et al (2022) Randomised trial of intravenous thiamine and/or magnesium sulphate administration on erythrocyte transketolase activity, lactate concentrations and alcohol withdrawal scores. Sci Rep 12:6941

Moskowitz A, Lee J, Donnino MW et al (2016) The association between admission magnesium concentrations and lactic acidosis in critical illness. J Intensive Care Med 31:187–192

Escuela MP, Guerra M, Añón JM et al (2005) Total and ionized serum magnesium in critically ill patients. Intensive Care Med 31:151–156

Jiang P, Lv Q, Lai T et al (2017) Does hypomagnesemia impact on the outcome of patients admitted to the intensive care unit? A systematic review and meta-analysis. Shock 47:288–295

Tonai K, Katayama S, Koyama K et al (2022) Association between hypomagnesemia and coagulopathy in sepsis: a retrospective observational study. BMC Anesthesiol 22:359

Thongprayoon C, Cheungpasitporn W, Erickson SB (2015) Admission hypomagnesemia linked to septic shock in patients with systemic inflammatory response syndrome. Ren Fail 37:1518–1521

Noormandi A, Khalili H, Mohammadi M et al (2020) Effect of magnesium supplementation on lactate clearance in critically ill patients with severe sepsis: a randomized clinical trial. Eur J Clin Pharmacol 76:175–184

Silva CM, Baptista JP, Mergulhão P et al (2022) Prognostic value of hyperlactatemia in infected patients admitted to intensive care units: a multicenter study. Rev Bras Ter Intensiva 34:154–162

Ryoo SM, Lee J, Lee YS et al (2018) Lactate level versus lactate clearance for predicting mortality in patients with septic shock defined by Sepsis-3. Crit Care Med 46:e489–e495

Kraft MD, Btaiche IF, Sacks GS et al (2005) Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm 62:1663–1682

Tazmini K, Nymo SH, Louch WE et al (2019) Electrolyte imbalances in an unselected population in an emergency department: a retrospective cohort study. PLoS ONE 14:e0215673

Green JP, Berger T, Garg N et al (2012) Hyperlactatemia affects the association of hyperglycemia with mortality in nondiabetic adults with sepsis. Acad Emerg Med 19:1268–1275

Pattharanitima P, Thongprayoon C, Kaewput W et al (2021) Machine learning prediction models for mortality in intensive care unit patients with lactic acidosis. J Clin Med 10:5021

Filho RR, Rocha LL, Corrêa TD et al (2016) Blood lactate levels cutoff and mortality prediction in sepsis-time for a reappraisal? A retrospective cohort study. Shock 46:480–485

Vine J, Lee JH, Kravitz MS, Grossestreuer AV et al (2024) Thiamine administration in septic shock: a post hoc analysis of two randomized trials. Crit Care 28(1):41

Fujii T, Salanti G, Belletti A, Bellomo R, Carr A, Furukawa TA et al (2022) Effect of adjunctive vitamin C, glucocorticoids, and vitamin B1 on longer-term mortality in adults with sepsis or septic shock: a systematic review and a component network meta-analysis. Intensive Care Med 48(1):16–24

Donnino MW, Carney E, Cocchi MN et al (2010) Thiamine deficiency in critically ill patients with sepsis. Journal Crit Care 25(4):576–581

Ricci Z, Romagnoli S (2018) The 11th pitfall: thiamine deficiency. Intensive Care Med 44(9):1597

Hansen BA, Bruserud Ø (2018) Hypomagnesemia in critically ill patients. J Intensive Care 6:21

Levraut J, Ciebiera JP, Chave S et al (1998) Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rather than overproduction. Am J Respir Crit Care Med 157:1021–1026

Huijgen HJ, Soesan M, Sanders R et al (2000) Magnesium levels in critically ill patients. What should we measure? Am J Clin Pathol 114:688–695

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Thông tin tác giả