Admission Serum Magnesium Levels Is Associated with Short and Long-Term Clinical Outcomes in COVID-19 Patients

Abstract

Background: In the face of the global pandemic that the coronavirus disease 2019 (COVID-19) has created, readily available prognostic markers may be of great use. Objective: To evaluate the association between serum magnesium (sMg) levels on admission and clinical outcomes in hospitalized COVID-19 patients. Methods: We retrospectively analyzed all patients admitted to a single tertiary center with a primary de novo diagnosis of COVID-19. Patients were followed for a mean of 10 ± 7 months. Demographic, clinical and laboratory data were collected and compared between five groups of patients according to sMg quintiles on hospital admission. Results: The cohort included 1522 patients (58% male, 69 ± 17 years old). A low sMg level (1st quintile) was associated with higher rates of diabetes and steroid use, whereas a high sMg level (5th quintile) was associated with dyslipidemia, renal dysfunction, higher levels of inflammatory markers and stay in the intensive care unit. All-cause in-hospital and long-term mortality was higher in patients with both low and high sMg levels, compared with mid-range sMg levels (2nd, 3rd and 4th quintiles; 19% and 30% vs. 9.5%, 10.7% and 17.8% and 35% and 45.3% vs. 23%, 26.8% and 27.3% respectively; p < 0.001 for all). After adjusting for significant clinical parameters indicating severe disease and renal dysfunction, only low sMg state was independently associated with increased mortality (HR = 1.57, p < 0.001). Conclusions: Both low and high sMg levels were associated with increased mortality in a large cohort of hospitalized COVID-19 patients. However, after correction for renal dysfunction and disease severity, only low sMg maintained its prognostic ability.

Serum Calcium and Magnesium Levels in Patients with Type 2 Diabetes and COVID-19 Infection Requiring Hospitalization—Correlations with Various Parameters

“…In our study, the magnesium level was predominantly normal at admission in the majority of patients included in the research, without influencing the survival or the severity of the viral infection. The decrease in serum magnesium levels with negative effects on the body's defense and inflammatory processes has been mentioned in the literature as a high-risk factor, not only for severe prognosis, but also for the development of complications associated with SARS-CoV-2 [56]. Another study described a direct link between hypomagnesemia and symptomatic forms of COVID-19, the persistence of long COVID in elderly patients, prolonged hospitalization, high mortality, as well as a correlation between obese patients with low serum magnesium levels and post-viral death [57].…”

The role of magnesium in cardiac arrest

“…Given the multiple effects of magnesium such as anti-inflammatory and antioxidant effects, it is assumed to play a significant role in COVID-19 development and mortality (47,(73)(74)(75)(76). Results from clinical studies found that the need for mechanical ventilation and mortality rates were higher in hypermagnesemia (magnesium levels > 2.4 mg/dL) and hypomagnesemia (<1.8 mg/dL) patients than in other patients who were hospitalized with COVID-19 (77,78). The COMEPA study found that the low level of serum magnesium was a significant indicator of the onset of long COVID symptoms, length of stay, and in-hospital mortality (79).…”

Serum Magnesium Is Associated with Long-Term Survival of Non-ST-Elevation Myocardial Infarction Patients

“…sMg levels are increased in patients with renal failure secondary to a reduction of magnesium's excretion in the urine [17]. Moreover, it has been shown that these elevations in sMg are not independently associated with poor outcomes but rather serve as a marker for severe renal dysfunction and its implications [18][19][20]. In our cohort, we witnessed an increase in sMg levels in patients with a creatinine clearance (CrCl) of less than 30 mL/min/1.73 m 2 , calculated by the CKD-EPI formula upon admission (Supplementary Figure S1).…”