Catarina Cidade-Rodrigues, Filipe M Cunha, Catarina Elias, Marta Carreira, Isaac Barroso, Paulo Bettencourt, Patrícia Lourenço
{"title":"镁对急性心力衰竭的预后影响因糖尿病的存在而异。","authors":"Catarina Cidade-Rodrigues, Filipe M Cunha, Catarina Elias, Marta Carreira, Isaac Barroso, Paulo Bettencourt, Patrícia Lourenço","doi":"10.1097/j.pbj.0000000000000197","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%), <i>P</i> < .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), <i>P</i> = .007, and 1.27 (95% confidence interval: 0.83-1.94) and <i>P</i> = .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.</p><p><strong>Conclusions: </strong>Higher magnesium levels were associated with worse prognosis only in HF patients with DM.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"7 6","pages":"e197"},"PeriodicalIF":0.0000,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a1/9d/pj9-7-e197.PMC10158881.pdf","citationCount":"0","resultStr":"{\"title\":\"The prognostic impact of magnesium in acute heart failure is different according to the presence of diabetes mellitus.\",\"authors\":\"Catarina Cidade-Rodrigues, Filipe M Cunha, Catarina Elias, Marta Carreira, Isaac Barroso, Paulo Bettencourt, Patrícia Lourenço\",\"doi\":\"10.1097/j.pbj.0000000000000197\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%), <i>P</i> < .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), <i>P</i> = .007, and 1.27 (95% confidence interval: 0.83-1.94) and <i>P</i> = .26 for non-DM patients. The results were similar if magnesium was analyzed as a continuous variable. 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引用次数: 0
摘要
背景:高镁血症可预测慢性心力衰竭(HF)患者的死亡率;然而，在急性心衰中，镁似乎与结果无关。糖尿病(DM)常与镁状态改变有关。我们假设糖尿病可能影响镁对急性心衰患者预后的影响。方法:对急性心衰住院患者进行回顾性队列研究。没有入院血清镁数据的患者被排除在外。随访:入院后1年。主要终点:全因死亡率。根据血清镁中位数(1.64 mEq/L)进行分组。采用Kaplan-Meier生存法根据镁水平确定生存曲线。根据DM的存在进行分层分析。采用多变量Cox回归分析研究镁对预后的影响。结果:我们研究了606例患者。平均年龄76±12岁，男性44.1%，糖尿病50.7%，随访期间死亡232例(38.3%)。镁的中位数为1.64 (1.48-1.79)mEq/L。镁≥1.64 mEq/L的患者1年死亡率更高[141 (46.4%)vs 91 (30.1%)， P < 0.001]。在调整了年龄、性别、房颤史、收缩压、心率、缺血性病因、b型利钠肽、肾小球滤过率、酒精摄入量、抗高血糖药物或糖化血红蛋白、入院血糖、纽约心脏协会IV级和严重左心室收缩功能障碍等因素后，血清镁≥1.64 mEq/L仅与DM患者的高死亡率相关:HR 1.89(95%可信区间:1.19-3.00)， P = 0.007，非糖尿病患者P = 1.27(95%可信区间:0.83-1.94)，P = 0.26。如果把镁作为一个连续变量来分析，结果是相似的。镁水平每增加0.1 mEq/L，糖尿病患者1年死亡率增加13%。结论:高镁水平仅与HF合并DM患者的预后差相关。
The prognostic impact of magnesium in acute heart failure is different according to the presence of diabetes mellitus.
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%), P < .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), P = .007, and 1.27 (95% confidence interval: 0.83-1.94) and P = .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.
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