Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2023 Aug;67(7):925-935. doi: 10.1111/aas.14247. Epub 2023 Apr 20.
Abnormal serum levels of magnesium, phosphate, and zinc appear common in intensive care unit (ICU) patients, but the epidemiology, management, and associations with outcomes are less well described. We described these factors and estimated associations with outcomes in a large dataset of Danish ICU patients.
We included adults who were acutely admitted to 10 general ICUs in Denmark between October 2011 and January 2018. From the dataset, we obtained characteristics of patients who had serum levels measured of magnesium, phosphate, or zinc, including data on supplementation. We used joint models with death as a competing outcome to estimate the associations between abnormal serum levels and time to successful extubation and, for magnesium, also incident tachyarrhythmia.
We included 16,517 of 36,514 patients in the dataset. The cumulative probability of hypomagnesemia within 28 days was 64% (95% confidence interval [CI] 62-66); of hypophosphatemia 74% (95% CI 72-75); and of hypozincemia 98% (95% CI 98-98). Supplementation of magnesium was used in 3554 out of 13,506 (26%) patients, phosphate in 2115 out of 14,148 (15%) patients, and zinc in 4465 out of 9869 (45%) patients. During ICU stay, 38% experienced hypermagnesemia, 58% hyperphosphatemia, and 1% hyperzincemia. Low serum levels of magnesium, phosphate, and zinc were associated with shorter time to successful extubation, and high serum magnesium and phosphate and low serum zinc with the competing risk of increased mortality, but too few serum measurements made the results inconclusive.
In this multicenter cohort study of acutely admitted ICU patients, most experienced low serum levels of magnesium, phosphate, or zinc during ICU stay, many received supplementation, and experiencing both low and high serum levels during ICU stay was not uncommon. Associations between serum levels and clinical outcomes appeared inconclusive because the data proved unfit for these analyses.
镁、磷和锌的血清水平异常在重症监护病房（ICU）患者中似乎很常见，但流行病学、管理以及与结局的关系描述得还不够详细。我们描述了这些因素，并在丹麦 ICU 患者的大型数据集上评估了它们与结局的关系。
我们纳入了 2011 年 10 月至 2018 年 1 月期间丹麦 10 家普通 ICU 急性入院的成年人。从数据集中，我们获得了镁、磷或锌血清水平测量的患者特征，包括补充数据。我们使用联合模型，以死亡为竞争结局，来估计异常血清水平与成功拔管时间之间的关系，对于镁，还估计了与心律失常事件的关系。
我们纳入了数据集内 36514 名患者中的 16517 名。28 天内低镁血症的累积概率为 64%（95%置信区间[CI]62-66）；低磷血症为 74%（95% CI 72-75）；低锌血症为 98%（95% CI 98-98）。在 13506 名患者中有 3554 名（26%）接受了镁补充，在 14148 名患者中有 2115 名（15%）接受了磷补充，在 9869 名患者中有 4465 名（45%）接受了锌补充。在 ICU 住院期间，38%的患者发生高镁血症，58%的患者发生高磷血症，1%的患者发生高锌血症。低镁、低磷和低锌血症与成功拔管时间较短有关，而高镁和高磷血症以及低锌血症与死亡率增加的竞争风险有关，但血清测量值太少，结果无法确定。
在这项对急性入住 ICU 患者的多中心队列研究中，大多数患者在 ICU 住院期间经历了镁、磷或锌的血清水平降低，许多患者接受了补充治疗，而在 ICU 住院期间同时经历低和高血清水平的情况并不少见。血清水平与临床结局之间的关系不明确，因为数据不适合这些分析。
