镁对急性心力衰竭的预后影响因糖尿病的存在与否而有所不同。
The prognostic impact of magnesium in acute heart failure is different according to the presence of diabetes mellitus.
作者信息
Cidade-Rodrigues Catarina, Cunha Filipe M, Elias Catarina, Carreira Marta, Barroso Isaac, Bettencourt Paulo, Lourenço Patrícia
机构信息
Endocrinology Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal.
Internal Medicine Department, Centro Hospitalar e Universitário do São João, Porto, Portugal.
出版信息
Porto Biomed J. 2022 Dec 1;7(6):e197. doi: 10.1097/j.pbj.0000000000000197. eCollection 2022 Nov-Dec.
BACKGROUND
Hypermagnesemia predicts mortality in chronic heart failure (HF); however, in acute HF, magnesium does not seem to be outcome-associated. Diabetes mellitus (DM) frequently associates with altered magnesium status. We hypothesized that DM might influence the prognostic impact of magnesium in acute HF.
METHODS
This is a retrospective cohort study of hospitalized patients with acute HF. Patients without data on admission serum magnesium were excluded. Follow-up: 1 year from hospital admission. Primary end point: all-cause mortality. Patients were divided according to median serum magnesium (1.64 mEq/L). The Kaplan-Meier survival method was used to determine survival curves according to magnesium levels. The analysis was stratified according to the presence of DM. A multivariable Cox regression analysis was used to study the prognostic impact of magnesium.
RESULTS
We studied 606 patients. The mean age was 76 ± 12 years, 44.1% were male, 50.7% had DM, and 232 (38.3%) died during follow-up. Median magnesium was 1.64 (1.48-1.79) mEq/L. Patients with magnesium ≥1.64 mEq/L had higher 1-year mortality [141 (46.4%) vs 91 (30.1%), < .001]. After adjustments for age, sex, history of atrial fibrillation, systolic blood pressure, heart rate, ischemic etiology, B-type natriuretic peptide, estimated glomerular filtration rate, alcohol consumption, antihyperglycaemic agents or glycated hemoglobin, admission glycemia, New York Heart Association class IV, and severe left ventricle systolic dysfunction, serum magnesium ≥1.64 mEq/L was associated with higher mortality only in patients with DM: HR 1.89 (95% confidence interval: 1.19-3.00), = .007, and 1.27 (95% confidence interval: 0.83-1.94) and = .26 for non-DM patients. The results were similar if magnesium was analyzed as a continuous variable. Per 0.1 mEq/L increase in magnesium levels, patients with DM had 13% increased risk of 1-year mortality.
CONCLUSIONS
Higher magnesium levels were associated with worse prognosis only in HF patients with DM.
背景
高镁血症可预测慢性心力衰竭（HF）患者的死亡率；然而，在急性HF中，镁似乎与预后无关。糖尿病（DM）常与镁状态改变相关。我们推测DM可能会影响镁在急性HF中的预后影响。
方法
这是一项对住院急性HF患者的回顾性队列研究。排除入院时血清镁数据缺失的患者。随访：自入院起1年。主要终点：全因死亡率。根据血清镁中位数（1.64 mEq/L）对患者进行分组。采用Kaplan-Meier生存法根据镁水平确定生存曲线。分析根据DM的存在进行分层。采用多变量Cox回归分析研究镁的预后影响。
结果
我们研究了606例患者。平均年龄为76±12岁，44.1%为男性，50.7%患有DM，232例（38.3%）在随访期间死亡。镁中位数为1.64（1.48 - 1.79）mEq/L。镁≥1.64 mEq/L的患者1年死亡率更高[141例（46.4%）对91例（30.1%），P <.001]。在对年龄、性别、房颤病史、收缩压、心率、缺血病因、B型利钠肽、估计肾小球滤过率、饮酒、降糖药物或糖化血红蛋白、入院血糖、纽约心脏协会IV级以及严重左心室收缩功能障碍进行校正后，血清镁≥1.64 mEq/L仅在DM患者中与较高死亡率相关：风险比（HR）为1.89（95%置信区间：1.19 - 3.00），P =.007，而非DM患者的HR为1.27（95%置信区间：0.83 - 1.94），P =.26。如果将镁作为连续变量进行分析，结果相似。镁水平每升高0.1 mEq/L，DM患者1年死亡风险增加13%。
结论
仅在患有DM的HF患者中，较高的镁水平与较差的预后相关。
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