Magnesium-to-Calcium Ratio and Mortality from COVID-19

Abstract

Obesity, type 2 diabetes, arterial hypertension, decrease in immune response, cytokine storm, endothelial dysfunction, and arrhythmias, which are frequent in COVID-19 patients, are associated with hypomagnesemia. Given that cellular influx and efflux of magnesium and calcium involve the same transporters, we aimed to evaluate the association of serum magnesium-to-calcium ratio with mortality from severe COVID-19. The clinical and laboratory data of 1064 patients, aged 60.3 ± 15.7 years, and hospitalized by COVID-19 from March 2020 to July 2021 were analyzed. The data of 554 (52%) patients discharged per death were compared with the data of 510 (48%) patients discharged per recovery. The ROC curve showed that the best cut-off point of the magnesium-to-calcium ratio for identifying individuals at high risk of mortality from COVID-19 was 0.20. The sensitivity and specificity were 83% and 24%. The adjusted multivariate regression model showed that the odds ratio between the magnesium-to-calcium ratio ≤0.20 and discharge per death from COVID-19 was 6.93 (95%CI 1.6–29.1) in the whole population, 4.93 (95%CI 1.4–19.1, p = 0.003) in men, and 3.93 (95%CI 1.6–9.3) in women. In conclusion, our results show that a magnesium-to-calcium ratio ≤0.20 is strongly associated with mortality in patients with severe COVID-19.

Prognostic Value of Magnesium in COVID-19: Findings from the COMEPA Study

“…Moreover, other studies reported an important role of Mg in the prognosis of patients affected by COVID-19. For example, Guerrero-Romero et al analyzed 1064 patients with COVID-19, showing a significant association between serum magnesium-calcium ratio and mortality in severe forms of the disease [ 27 ]. Similarly, a retrospective cohort study analyzing 390 hospitalized patients with COVID-19 showed that reduced kidney function and lower serum Mg levels were associated with increased mortality in obese patients affected by COVID-19 [ 30 ].…”

“…Recently, some works explored the possible role of Mg in COVID-19 to predict the prognosis in these patients [ 26 , 27 , 28 , 29 , 30 ]. However, no study so far has examined the role of Mg for long COVID prediction, an increasing entity with limited therapeutical options [ 31 ].…”

The role of electrolyte imbalances in predicting the severity of COVID-19 in the hospitalized patients: a cross-sectional study

“…These changes decrease the activity of sulfotransferase enzyme 2B1b (SULT2B1b), as a result of which the sulfurylation of cholesterol to cholesterol sulfate is reduced. The reduction of cholesterol sulfate reduces the electrical charge of red blood cells and increases the risk of agglutination and thrombosis 42 , 43 . The low serum level of Magnesium and Na has been shown in patients who are admitted to ICU in a study from Iran 44 .…”

Magnesium Status and Ca/Mg Ratios in a Series of Children and Adolescents with Chronic Diseases

“…With a serum Mg/Ca ratio of 0.4, the optimal and the range from 0.36 to 0.28 was too low; the serum Mg/Ca ratio of our results of 0.21 was very low, and 49% (38 cases) of patients were below 0.20. Data from 1064 patients aged 60 years and hospitalized by COVID-19 show that an Mg/Ca ratio ≤ 0.20 is powerfully related with mortality in patients with severe COVID-19 [ 165 ]. The Mg/Ca ratio ≤ 0.20 is used as a mortality predictor in patients with CV and neoplastic illnesses [ 165 , 166 ].…”

“…Data from 1064 patients aged 60 years and hospitalized by COVID-19 show that an Mg/Ca ratio ≤ 0.20 is powerfully related with mortality in patients with severe COVID-19 [ 165 ]. The Mg/Ca ratio ≤ 0.20 is used as a mortality predictor in patients with CV and neoplastic illnesses [ 165 , 166 ]. These results support the high risk in our series of developing chronic diseases and an increased risk of mortality.…”