低镁血症对入住医疗重症监护病房的中老年患者谵妄的影响。

The effects of hypomagnesemia on delirium in middle-aged and older adult patients admitted to medical intensive care units.

作者信息

Kim Joong-Yub, Lee Hyo Jin, Lee Hong Yeul, Lee Sang-Min, Lee Jinwoo, Park Tae Yun

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

出版信息

Acute Crit Care. 2022 Aug;37(3):407-414. doi: 10.4266/acc.2022.00164. Epub 2022 Jul 5.

DOI:10.4266/acc.2022.00164

PMID:35791650

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9475148/

Abstract

BACKGROUND

In critically ill patients, the most common manifestation of brain dysfunction is delirium, which is independently associated with higher morbidity and mortality. While electrolyte imbalance is one of the precipitating factors, the impact of hypomagnesemia on the incidence of delirium remains unknown.

METHODS

We retrospectively analyzed patients admitted to the medical intensive care unit (ICU) of a tertiary referral center between January and June 2020. Patients with ICU stay ≥48 hours and aged 40-85 years were included. The primary outcome was cumulative incidence of delirium in the ICU. Patients were divided into two groups based on serum magnesium level at ICU admission. Multivariable Cox proportional hazards regression analysis was performed, and covariates were selected using the least absolute shrinkage and selection operator (LASSO) method.

RESULTS

A total of 109 patients included 43 (39.4%) women and had a median age of 69.0 years (interquartile range [IQR], 60.0-76.0 years). The median magnesium level was 1.7 mg/dl (IQR, 1.5-1.9 mg/dl), and the cumulative incidence of delirium was 32.1% (35 patients). Hypomagnesemia was independently associated with delirium (adjusted hazard ratio [aHR], 2.12; 95% confidence interval [CI], 1.03-4.38), along with prior use of immunosuppressants (aHR, 3.08; 95% CI, 1.46-6.48) or benzodiazepines (aHR, 4.02; 95% CI, 1.54-10.50), body mass index (aHR, 0.93; 95% CI, 0.84-1.02), and alcohol history (aHR, 1.68; 95% CI, 0.74-3.80).

CONCLUSIONS

In critically ill adults, hypomagnesemia increases the risk of delirium by more than two-fold compared to patients with normal magnesium level.

摘要

背景

在危重症患者中，脑功能障碍最常见的表现是谵妄，其与更高的发病率和死亡率独立相关。虽然电解质失衡是诱发因素之一，但低镁血症对谵妄发生率的影响尚不清楚。

方法

我们回顾性分析了2020年1月至6月间入住一家三级转诊中心医学重症监护病房（ICU）的患者。纳入入住ICU≥48小时且年龄在40 - 85岁之间的患者。主要结局是ICU中谵妄的累积发生率。根据ICU入院时的血清镁水平将患者分为两组。进行多变量Cox比例风险回归分析，并使用最小绝对收缩和选择算子（LASSO）方法选择协变量。

结果

总共109例患者，其中43例（39.4%）为女性，中位年龄为69.0岁（四分位间距[IQR]，60.0 - 76.0岁）。中位镁水平为1.7mg/dl（IQR，1.5 - 1.9mg/dl），谵妄的累积发生率为32.1%（35例患者）。低镁血症与谵妄独立相关（调整后风险比[aHR]，2.12；95%置信区间[CI]，1.03 - 4.38），同时还与先前使用免疫抑制剂（aHR，3.08；95%CI，1.46 - 6.48）或苯二氮䓬类药物（aHR，4.02；95%CI，1.54 - 10.50）、体重指数（aHR，0.93；95%CI，0.84 - 1.02）以及饮酒史（aHR，1.68；95%CI，0.74 - 3.80）有关。