Tonai Ken, Katayama Shinshu, Koyama Kansuke, Imahase Hisashi, Nunomiya Shin
Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
J Anesth Analg Crit Care. 2024 Apr 3;4(1):23. doi: 10.1186/s44158-024-00158-2.
Sepsis-3 emphasizes the recognition of sepsis-induced cellular metabolic abnormalities, and utilizes serum lactate level as a biomarker of cellular metabolic abnormalities. Magnesium plays an important role as a cofactor in glucose metabolism, although it is not well known that magnesium deficiency causes elevated serum lactate levels. Additionally, it remains unclear how magnesium status affects the role of serum lactate levels as a marker of metabolic abnormalities in sepsis. Thus, this study aimed to investigate the association between serum magnesium and lactate levels in patients with sepsis and explore this relationship from the perspectives of time course and circulatory abnormalities.
This retrospective observational study of adult patients with sepsis was performed at the 16-bed intensive care unit of Jichi Medical University Hospital between June 2011 and December 2017. The relationship between serum magnesium and lactate levels for 5 days from intensive care unit admission was investigated along the time course. Multivariate logistic regression analysis was performed to evaluate the association between serum magnesium and lactate levels during intensive care unit admission.
Among 759 patients included, 105 had hypomagnesemia (magnesium level < 1.6 mg/dL), 558 had normal serum magnesium levels (1.6-2.4 mg/dL), and 96 had hypermagnesemia (magnesium level > 2.4 mg/dL) at intensive care unit admission. From intensive care unit admission to day 5, the hypomagnesemia group had higher serum lactate levels and a higher frequency of lactic acidosis than the normal magnesium level and hypermagnesemia groups (70% vs. 51.6% vs. 50%; P < 0.001). Hypomagnesemia at intensive care unit admission was independently associated with lactic acidosis, i.e., lactic acid level > 2 mmol/L (odds ratio, 2.76; 95% confidence interval, 1.60-4.76; P < 0.001).
Hypomagnesemia was associated with serum lactate levels in the early and post-resuscitation phases of sepsis. Further studies are needed to elucidate whether the magnesium status is associated with sepsis-induced cellular and metabolic abnormalities.
脓毒症-3强调对脓毒症诱导的细胞代谢异常的认识，并将血清乳酸水平用作细胞代谢异常的生物标志物。镁作为葡萄糖代谢中的辅助因子发挥着重要作用，尽管镁缺乏会导致血清乳酸水平升高这一点并不广为人知。此外，镁状态如何影响血清乳酸水平作为脓毒症代谢异常标志物的作用仍不清楚。因此，本研究旨在调查脓毒症患者血清镁与乳酸水平之间的关联，并从时间进程和循环异常的角度探讨这种关系。
本研究为对成年脓毒症患者的回顾性观察研究，于2011年6月至2017年12月在秩父医科大学医院拥有16张床位的重症监护病房进行。沿着时间进程调查了从重症监护病房入院起5天内血清镁与乳酸水平之间的关系。进行多变量逻辑回归分析以评估重症监护病房入院期间血清镁与乳酸水平之间的关联。
在纳入的759例患者中，105例在重症监护病房入院时存在低镁血症（镁水平<1.6mg/dL），558例血清镁水平正常（1.6 - 2.4mg/dL），96例存在高镁血症（镁水平>2.4mg/dL）。从重症监护病房入院到第5天，低镁血症组的血清乳酸水平和乳酸酸中毒发生率高于正常镁水平组和高镁血症组（70%对51.6%对50%；P<0.001）。重症监护病房入院时的低镁血症与乳酸酸中毒独立相关，即乳酸水平>2mmol/L（比值比，2.76；95%置信区间，1.60 - 4.76；P<0.001）。
低镁血症与脓毒症早期及复苏后阶段的血清乳酸水平相关。需要进一步研究以阐明镁状态是否与脓毒症诱导的细胞和代谢异常相关。
