Sanjukta MukhopadhyayKing George Medical University, India
Title: Serum Magnesium levels in severe pneumonia and its association with clinical severity (on the day of admission using the PRESS and the modified PIRO scoring system) and adverse outcomes in children <5 years of age: A nested case-control study in Northern India
Background: Hypomagnesemia is associated with the increased release of endothelin and proinflammatory cytokines and increased pyroptosis as Mg inhibits the non-canonical pyroptosis. Increased mortality in sepsis with hypomagnesemia is due to the upregulation of the release of inflammatory cytokines (tumor necrosis factor-alpha, interleukin-6). Objectives – Primary objective was to assess magnesium levels in patients with severe pneumonia and its association with clinical severity and adverse outcomes. The secondary objective was to study the association of magnesium serum calcium and phosphorus levels controlling for nutritional status.
Material & Methods: 110 patients admitted with severe pneumonia were enrolled. Their blood samples were collected and assessed for serum magnesium using the Selectra PRO M autoanalyzer. Data collected was used for 2 prospective scoring systems modified PIRO score and PRESS scoring system. ROC was generated for respective scores. Logistic regression analysis was done for determining the determinants of mortality. After obtaining results of serum magnesium, the recruited patients were divided into two groups, group A (magnesium<1.7mg/dl), and group B (magnesium level ? 1.7mg/dl), for further evaluation.
Result: Hypomagnesemia (<1.7mg/dl) was found to be present in 52 /110 (47.3%). Vaccination status (OR 4.17), longer duration of hospital stays (>30 days) (OR-1.9), presence of fever >7 days, poor feeding (OR-3.03), larger family size, exclusive breastfeeding, refusal to feed, arterial saturation <90%, and presence of danger signs (OR-4.57) were significantly associated (p < 0.05) with hypomagnesemia. The mean PRESS score of patients in group A was 3.52±1.15 and patients of group B were 2.66±1.25. The mean PIRO score of patients of group A was 4.38±2.43 and group B 2.55±1.97. The adverse outcomes- mechanical ventilation (61.5%), prolonged use of oxygen >14days (63.5%), persistent high-grade fever (65.4%), the appearance of danger signs (42.3%) shock (36.5%), mortality (58%) was higher in patients of group A and were statistically significant (<0.001). A simple linear regression was calculated to predict CRP based on serum magnesium. CRP is increased by 31.15mg/dl for each mg/dl decrease in serum magnesium. The AUC for the modified PIRO score for prediction of mortality was 0.816 and for the modified PIRO score was 0.917, and magnesium was 0.473. There was a strong negative correlation between magnesium levels and adverse outcomes as seen by Pearson correlation. Using the logistic regression analysis, we found that controlling for hypoxia and severity of illness, hypomagnesemia is an independent risk factor for mortality in patients with severe pneumonia. There was a strong positive correlation between magnesium and serum calcium and phosphorus as seen by the Pearson correlation.
Conclusion: Serum magnesium levels were decreased in 47.3% of patients with severe pneumonia (52/110). This is a strong association of hypomagnesemia with mortality according to our study and hypomagnesemia is an independent indicator of mortality, hence serum magnesium should be screened regularly in the PICU and should be supplemented to patients with prolonged mechanical ventilation.
Sanjukta Mukhopadhyay had completed her MBBS in 2018. She is a university topper and a gold medalist. She is currently persuading her MD pediatrics. she had been awarded multiple awards for her case reports on RTA, and COVID 19 related ALF.