The Impact of Hypomagnesemia on the Prognosis of Elderly Patients with Sepsis

The Impact of Hypomagnesemia on the Prognosis of Elderly Patients with Sepsis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Impact of Hypomagnesemia on the Prognosis of Elderly Patients with Sepsis Tao Li, Yan Liu, Yunxia Hu, Yina Wu, Jun Duan, Ping Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8942415/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Objective To evaluate the association between hypomagnesemia and in-hospital all-cause mortality in elderly patients with sepsis. Methods A retrospective analysis was performed on elderly patients (60–80 years old) with sepsis admitted to the Department of Critical Care Medicine of our hospital from August 2022 to July 2024. Eligible patients were divided into the hypomagnesemia group (serum magnesium < 1.46 mg/dL) and the normal magnesium group based on their serum magnesium levels at admission. The mortality difference between the two groups was compared, and univariate analysis was first conducted followed by multivariate Logistic regression to identify independent risk factors for in-hospital mortality. Results A total of 255 elderly patients were included, with 99 in the hypomagnesemia group. The mortality rate of the hypomagnesemia group was 34.3%, which was significantly higher than that of the normal magnesium group (9.0%), with a statistically significant difference (p < 0.05). High Sequential Organ Failure Assessment (SOFA) score, mechanical ventilation, and hypomagnesemia were independent risk factors for in-hospital all-cause mortality in elderly patients with sepsis (OR = 2.63, 2.14, 3.01, all p < 0.05). Conclusion Hypomagnesemia is an independent risk factor for in-hospital all-cause mortality in elderly patients with sepsis. Attention should be paid to maintaining normal serum magnesium levels during the management of these patients. Hypomagnesemia Elderly Sepsis In-hospital All-cause Mortality Figures Figure 1 Introduction Magnesium is the fourth most abundant element in the human body and the second most abundant cation in human cells. It plays a crucial role in numerous physiological functions, particularly serving as an important cofactor in various enzyme-catalyzed reactions [ 1 ]. The normal range of serum magnesium is 1.46–2.68 mg/dL; thus, hypomagnesemia is defined as a serum magnesium level below 1.46 mg/dL. The incidence of hypomagnesemia is 2% in the general population, 10%–20% in hospitalized patients, and 50%–60% in intensive care unit (ICU) patients [ 2 ]. As an underrecognized electrolyte disorder, hypomagnesemia is closely associated with the pathophysiology of various diseases in critically ill patients, and multiple studies have confirmed its association with poor prognosis in this population [ 3 ]. Magnesium ions also play a key role in immune processes: by regulating inflammatory responses and nitric oxide production, they exert a critical effect on the body’s resistance to infections [ 4 ]. Sepsis, conversely, is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection [ 5 ]. Current studies have confirmed that sepsis is an independent risk factor for hypomagnesemia in critically ill medical patients [ 6 ]. However, there are relatively few studies on the impact of hypomagnesemia on the prognosis of adult patients with sepsis. Herein, we report this retrospective study to provide a theoretical basis for optimizing future clinical diagnosis and treatment protocols. Materials and Methods Study design A retrospective analysis was conducted on patients with sepsis admitted to the Department of Critical Care Medicine of our hospital from August 2022 to July 2024. According to the Sepsis-3.0 definition, sepsis was defined as “life-threatening organ dysfunction (assessed by a Sequential Organ Failure Assessment [SOFA] score ≥ 2) caused by a dysregulated host response to infection” [ 5 ]. Infection was defined as “positive microbial culture results, or clinical manifestations suggestive of infection (even with negative culture results) supported by radiological findings or clinical presentations”. Sepsis management was performed using bundled strategies in accordance with the latest clinical guidelines [ 7 ]. This study was approved by the Hospital Ethics Committee (Approval No. : 2022-KY-116), and the requirement for informed consent was waived by the committee due to the retrospective nature of the study. Inclusion and exclusion criteria for cases Medical records of all patients diagnosed with sepsis at admission were retrospectively reviewed, and only those whose diagnosis was consistent with the Sepsis-3.0 definition were included. Inclusion criteria : (1) Aged 60–80 years old; (2) Availability of serum magnesium test results within 24 hours of admission; (3) Complete clinical data; (4) Received continuous treatment at our hospital. Exclusion criteria : (1) Aged 80 years old; (2) Incomplete test data or clinical information; (3) Discontinued treatment midway (including voluntary discharge against medical advice, transfer to other hospitals, or withdrawal of life-sustaining treatment). The flowchart of case inclusion is shown in Fig. 1. Figure 1. Flow of patients in the study Data collection Hypomagnesemia was defined as a serum magnesium level < 1.46 mg/dL. Serum magnesium was detected using the xylene blue method on Beckman AU5800 or AU5821 analyzers, which were calibrated monthly with standard reference materials; all samples were fasting serum collected within 24 hours of admission. Collected data included: demographic and clinical baseline characteristics (age, gender, body mass index); comorbidities (hypertension, diabetes mellitus, cerebrovascular disease, coronary heart disease, chronic respiratory disease, chronic liver disease, chronic kidney disease, connective tissue disease); infection sources (central nervous system, lung, abdominal cavity, urinary system, skin and soft tissue, indwelling catheters); clinical characteristics (Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, SOFA score); laboratory characteristics (procalcitonin, platelets, albumin, arterial blood lactic acid, troponin T, and pathogen culture data); organ support measures (use of vasoactive agents, mechanical ventilation, renal replacement therapy); occurrence of in-hospital death. A positive pathogen culture was defined as the growth of at least one microorganism in body fluids (urine, blood, bronchoalveolar lavage fluid, ascites) or biopsy specimens. For patients with negative pathogen cultures, infection was confirmed via metagenomic next-generation sequencing (mNGS) of clinical samples, with a positive result defined as detection of pathogen-specific sequences above the background contamination threshold. Statistical analysis Data were processed using SPSS 18.0 statistical software. Measurement data were expressed as mean ± standard deviation (x̄ ± s) and compared using analysis of variance (ANOVA). Categorical data were expressed as rates (%) and compared using the chi-square test (χ² test). Univariate analysis was first performed to screen potential risk factors for in-hospital all-cause mortality, and variables with P < 0.1 in univariate analysis were included in multivariate Logistic regression to identify independent risk factors. A value of P < 0.05 was considered statistically significant. Results Clinical characteristics of patients A total of 255 elderly patients were included, among whom 99 (38.8%) had hypomagnesemia. There were no statistically significant differences between the two groups in terms of age, gender, body mass index, comorbidities, or infection sources (all P > 0.05). However, significant differences were observed in organ support therapy and ICU length of stay between the two groups (both P < 0.05). The comparison of baseline characteristics between the two groups is shown in Table 1 . During hospitalization, 34 patients in the hypomagnesemia group died, with a mortality rate of 34.3%, which was significantly higher than that in the normal magnesium group (P < 0.001). Table 1 Comparison of baseline clinical characteristics between the two groups of patients Patient Features All patients (n = 255) Hypomagnesemia (n = 99) Normal Serum Magnesium (n = 156) P-value Age, yrs 69.1 ± 4.2 72.3 ± 4.1 68.2 ± 4.2 0.141 Men/women, n 145/110 57/42 88/68 0.892 BMI (kg/m²) 22.1 ± 4.3 21.4 ± 5.5 22.6 ± 3.5 0.085 comorbidity Hypertension, n (%) 85(33.3) 34(34.3) 51(32.7) 0.786 Diabetes mellitus, n (%) 46(18.0) 15(15.2) 31(19.9) 0.335 Cerebrovascular disease, n (%) 22(8.6) 9(9.1) 13(8.4) 0.831 Coronary heart disease, n (%) 28(11.0) 12(12.1) 16(10.3) 0.647 Chronic respiratory disease, n (%) 20(7.8) 9(9.1) 11(7.1) 0.568 Chronic liver disease, n (%) 12(4.7) 5(5.1) 7(4.5) 0.824 Chronic kidney disease, n (%) 17(6.7) 7(7.1) 10(6.4) 0.815 Connective tissue disease, n (%) 13(5.1) 4(4.0) 9(5.8) 0.489 Source of infection 0.891 Central nervous system, n (%) 3(1.2) 1(1.0) 2(1.2) Lung, n (%) 95(37.3) 39(39.4) 56(35.9) Abdomen, n (%) 105(41.2) 40(40.4) 65(41.6) Urinary system, n (%) 34(13.3) 12(12.1) 22(14.1) Skin and soft tissue, n (%) 11(4.3) 4(4.0) 7(4.5) Indwelling catheter, n (%) 7(2.7) 3(3.0) 4(2.6) Positive pathogen culture, n (%) 90(35.3) 35(35.4) 55(35.3) 0.984 APACHE Ⅱ score 16.6 ± 5.1 21.3 ± 3.3 13.8 ± 4.4 <0.001 SOFA score 6.0 ± 3.7 7.2 ± 3.5 5.1 ± 3.8 <0.001 Procalcitonin (ng/ml) 11.6 ± 7.5 18.3 ± 7.3 6.8 ± 5.7 <0.001 Platelet count (×10⁹/L) 104 ± 77 79 ± 64 121 ± 82 <0.001 Albumin level (g/L) 28.2 ± 7.8 24.7 ± 8.6 30.6 ± 6.2 <0.001 Troponin T (pg/mL) 0.14 ± 0.08 0.15 ± 0.07 0.13 ± 0.08 0.115 Arterial blood lactic acid (mmol/L) 3.8 ± 2.8 6.1 ± 2.5 2.3 ± 2.2 <0.001 Vasopressor use, n (%) 159(62.4) 91(91.9) 68(43.6) <0.001 Mechanical ventilation, n (%) 123(48.2) 65(65.7) 58(37.2) <0.001 Renal replacement therapy, n (%) 72(28.2) 41(41.4) 31(19.9) <0.001 Length of ICU stay (d) 9.7 ± 5.3 11.2 ± 5.2 8.7 ± 5.4 0.001 In-hospital all-cause mortality (%) 48(18.8) 34(34.3) 14(9.0) <0.001 Predictors of hypomagnesemia in patients with sepsis Among the 255 elderly patients, hypomagnesemia was set as the dependent variable. After univariate analysis followed by multivariate regression analysis, high SOFA score, low platelet count, use of vasoactive agents, and mechanical ventilation were identified as independent predictors of hypomagnesemia in patients with sepsis (Table 2 ). Table 2 Multivariate Logistic Regression Analysis of Risk Factors for Hypomagnesemia Independent Variable Regression Coefficient (B) Standard Error (SE) Wald χ² Value Degrees of Freedom (df) Odds Ratio (OR) P Value 95% Confidence Interval (95%CI) SOFA Score 0.073 0.062 8.347 1 2.73 0.021 1.58–3.06 Platelet Count (×10⁹/L) 0.368 0.527 5.364 1 0.74 0.037 0.63–0.92 Vasopressor Use 0.348 0.316 5.375 1 2.82 0.022 2.01–4.15 Mechanical Ventilation 0.168 0.047 4.742 1 1.52 0.033 1.54–4.01 Predictors of all-cause in-hospital mortality in patients Among the 255 elderly patients, in-hospital death was set as the dependent variable. Univariate analysis was first conducted, and further multivariate regression analysis revealed that high SOFA score, hypomagnesemia, and mechanical ventilation were independent predictors of in-hospital death in elderly patients with sepsis (Table 3 ). Table 3 Predictors of In-Hospital All-Cause Mortality in Adult Patients with Sepsis Factor Regression Coefficient (B) Standard Error (SE) Wald χ² Value Degrees of Freedom (df) Odds Ratio (OR) P Value 95% Confidence Interval (95%CI) SOFA Score 0.063 0.028 4.742 1 2.63 0.015 1.83–4.01 Hypomagnesemia 0.092 0.051 3.946 1 2.14 0.003 1.63–3.89 Mechanical Ventilation 0.062 0.056 2.916 1 3.01 0.011 2.01–4.72 Discussion Electrolyte disturbances are the most common issues in patients admitted to the Department of Critical Care Medicine. Hypomagnesemia, which has a high incidence among critically ill patients, is associated with the development of systemic inflammatory response syndrome (SIRS) and even organ dysfunction [ 8 ]. Therefore, magnesium deficiency in patients with sepsis may lead to poor prognosis. Our study confirmed that hypomagnesemia is associated with increased in-hospital mortality in elderly patients with sepsis; it is also linked to higher disease severity, lower platelet counts, greater need for organ support, and longer ICU stays. Further analysis revealed that hypomagnesemia is an independent predictor of in-hospital death in elderly patients with sepsis. Thus, during the clinical management of elderly patients with sepsis, emphasis should be placed on monitoring serum magnesium levels and maintaining them within the normal range. Accurate measurement of magnesium content in the human body is nearly impossible, as 99% of the body’s magnesium is primarily located inside cells, and there is currently no simple method to detect total body magnesium. However, in reality, it is the ionic magnesium within cells that holds the greatest physiological significance [ 9 ]. The physiological regulation of magnesium occurs primarily through three mechanisms: intestinal absorption, renal reabsorption/excretion, and exchange with the body’s magnesium pool (i.e., bones) [ 10 ]. In our study, 38.8% of the subjects had hypomagnesemia, indicating a relatively high incidence of hypomagnesemia in patients with sepsis. This result is consistent with epidemiological surveys, which report that the incidence of hypomagnesemia in elderly critically ill patients ranges from approximately 20% to 60% [ 11 ], with variations attributed to differences in definition criteria, study populations, and detection methods across different literatures [ 12 ]. For example, a study by Piano et al. showed that the incidence of hypomagnesemia in elderly critically ill patients was 52.3% [ 13 ]; other studies have compared serum magnesium levels and found that among adult critically ill patients, the average serum magnesium level in the hypomagnesemia group was approximately 1.23 ± 0.18 to 1.52 ± 0.0768 mg/dl, while that in the normal magnesium group was 1.89 ± 0.12 to 2.038 ± 0.23 mg/dl [ 3 ]. Despite minor differences in specific values, there is a clear clinical consensus: serum magnesium levels in critically ill patients must be monitored to enable timely intervention and improve prognosis. Magnesium is an essential element in the human body. It not only participates in physiological activities in ionic form but also acts as a key enzymatic cofactor, regulating metabolism, protein synthesis, and the maintenance of cellular integrity [ 1 ]. Its complex association with the immune system has been extensively studied, and a large body of evidence confirms that magnesium can regulate both non-specific and specific immune responses [ 14 ]. Animal studies have shown that magnesium deficiency activates the non-specific immune system, impairs the specific immune system, and thereby induces a pro-inflammatory state: at the level of non-specific immunity, magnesium deficiency activates polymorphonuclear leukocytes, increasing phagocytosis and oxidative stress [ 15 ], while magnesium supplementation can reduce cytokine production in monocytes via the Toll-like receptor pathway [ 16 ]; at the level of specific immunity, magnesium regulates adaptive immunity by influencing the development and proliferation of lymphocytes—magnesium deficiency in mice leads to early thymic degeneration and reduced T cell counts. Among these processes, the magnesium ion transporter TRPM7 (Transient Receptor Potential Cation Channel Subfamily M Member 7) is crucial for T cell development: its deletion results in insufficient magnesium supply, inhibiting T cell development and triggering apoptosis (this effect can be partially reversed by culturing cells in a high-magnesium medium). In mice with T cell-specific deletion of TRPM7, T lymphocyte development is impaired at the CD4⁻CD8 stage, leading to decreased levels of CD4⁺ and CD4⁺CD8⁺ cells in the thymus [ 17 ]. Additionally, extracellular magnesium can regulate the effector function of CD8⁺ T cells through a pathway mediated by the co-stimulatory molecule Lymphocyte Function-Associated Antigen 1 [ 18 ]. Based on these mechanisms, even moderate or subclinical magnesium deficiency may promote chronic inflammation by activating leukocytes and macrophages, releasing inflammatory cytokines and acute-phase proteins, and overproducing free radicals. The pathophysiological association between serum magnesium and sepsis has not been fully clarified, but existing literature indicates that sepsis is an independent risk factor for hypomagnesemia in critically ill patients [ 6 ]. The potential mechanisms by which sepsis induces hypomagnesemia include: impaired gastrointestinal function due to inflammatory responses, which affects magnesium absorption; large-volume fluid resuscitation with electrolyte solutions that do not contain magnesium ions; combined metabolic acidosis causing serum magnesium to shift into cells; and impaired renal tubular reabsorption of serum magnesium due to renal function damage [ 19 ]. Both animal and clinical studies have confirmed the association between hypomagnesemia and adverse progression of sepsis: animal experiments show that hypomagnesemia increases the levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), and enhances the activation of macrophages, neutrophils, and endothelial cells; in contrast, magnesium supplementation can protect mice from lipopolysaccharide (LPS)-induced fatal septic shock by blocking gasdermin-D-induced cell apoptosis [ 20 ]. In clinical studies, hypomagnesemia is significantly associated with an increased incidence of sepsis or septic shock—a study involving 280 patients with systemic inflammatory response syndrome (SIRS) found that patients with hypomagnesemia (defined as a magnesium level < 1.5 mg/dL) at admission had a 1.75-fold higher risk of progressing to septic shock during hospitalization [ 21 ]. A prospective study by Laddhad et al. and a study by Cheungpasitporn et al. both noted that septic patients with hypomagnesemia had higher Sequential Organ Failure Assessment (SOFA) scores and Acute Physiology and Chronic Health Evaluation (APACHE) scores, as well as longer durations of ventilator support and ICU stays [ 11 , 23 ]. Tong Fei et al. also confirmed that hypomagnesemia significantly increases mortality in patients with severe sepsis [ 22 ], which is consistent with our study’s conclusion that "hypomagnesemia increases mortality in patients with sepsis." Given that hypomagnesemia exacerbates the poor prognosis of sepsis through mechanisms such as inflammatory activation and immune impairment, magnesium supplementation offers multi-dimensional benefits to elderly patients with sepsis, which are highly aligned with the physiological characteristics of the elderly population and the pathological mechanisms of sepsis [ 24 ]: in terms of survival prognosis, regardless of whether elderly patients have normal baseline serum magnesium levels, magnesium sulfate supplementation can significantly reduce 28-day all-cause mortality, ICU mortality, and in-hospital mortality. This association remains stable in subgroup analyses involving patients with different comorbidity severities, effectively improving survival outcomes [ 25 ]; in terms of organ protection, magnesium supplementation reduces the need for renal replacement therapy, which is particularly important for elderly patients with declining renal function reserves and helps lower the risk of treatment-related complications; in terms of metabolic improvement, as an enzymatic cofactor involved in energy metabolism, magnesium accelerates lactate clearance, shortens lactate clearance time, corrects tissue hypoperfusion and metabolic disorders common in elderly septic patients, and reduces multi-organ damage [ 26 ]; furthermore, the anti-inflammatory, antioxidant, and immunomodulatory effects of magnesium can specifically alleviate the excessive inflammatory response and immunosuppressive state caused by immunosenescence in elderly patients, enhancing the body’s ability to fight infections [ 27 ]. Although elderly patients often have multiple underlying diseases and complex medication regimens, existing studies confirm that rational magnesium supplementation improves prognosis without additional safety risks, providing important references for clinical treatment. In conclusion, hypomagnesemia increases in-hospital all-cause mortality in patients with sepsis and serves as an independent predictor of this outcome. Therefore, in clinical practice, it is necessary to strengthen the monitoring of serum magnesium levels in patients with sepsis, promptly detect hypomagnesemia, and implement early intervention to further improve overall prognosis. However, this study is a single-center retrospective study with a small sample size, and its conclusions still require verification through multi-center randomized controlled studies. Abbreviations SOFA Sequential organ failure assessment ICU Intensive care unit APACHE Ⅱ Acute physiology and chronic health evaluation Ⅱ mNGS metagenomic Next-generation sequencing SIRS systemic inflammatory response syndrome TRPM7 Transient Receptor Potential Cation Channel Subfamily M Member 7 IL-6 Interleukin-6 TNF-α Tumor necrosis factor-α LPS lipopolysaccharide Declarations Consent for publication All the authors consent to the publication of the manuscript and related materials. Ethics approval and consent to participate This study adhered to the Declaration of Helsinki. This study was approved by the Hospital Ethics Committee (Approval No.: 2022-KY-116), and the requirement for informed consent was waived by the committee due to the retrospective nature of the study. Competing interests The authors declare no competing interests. Clinical trial number not applicable. Funding: No funding was received for this article. Author Contribution All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Tao Li, Yina Wu, Ping Wang, and the research design was performed by Jun Duan. The first draft of the manuscript was written by Yan Liu, Yunxia Hu, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript. Acknowledgement We would like to express our thanks to all of the recruited participants. Data availability: The data used to support the findings of this study are included within the article. References Ray E, Mohan K, Ahmad S, et al. Physiology of a Forgotten Electrolyte-Magnesium Disorders. Adv Kidney Dis Health. 2023;30(2):148–163. Touyz RM, de Baaij JHF, Hoenderop JGJ. Magnesium Disorders. N Engl J Med. 2024;390(21):1998–2009. Fairley J, Glassford NJ, Zhang L, et al. Magnesium status and magnesium therapy in critically ill patients: A systematic review. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8942415","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617356962,"identity":"16bc3a94-9949-45ce-969a-b4863882e628","order_by":0,"name":"Tao Li","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Li","suffix":""},{"id":617356965,"identity":"36a5b5d4-02e3-44d0-8784-1ad5cf1c51bd","order_by":1,"name":"Yan Liu","email":"","orcid":"","institution":"Xinjiang Production \u0026Construction Corps Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Liu","suffix":""},{"id":617356969,"identity":"4431e624-bd79-4536-8e69-9d870af3a5d7","order_by":2,"name":"Yunxia Hu","email":"","orcid":"","institution":"Xinjiang Production \u0026Construction Corps Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yunxia","middleName":"","lastName":"Hu","suffix":""},{"id":617356971,"identity":"18b9d381-b102-426c-8c51-1b00d12c6d34","order_by":3,"name":"Yina Wu","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yina","middleName":"","lastName":"Wu","suffix":""},{"id":617356972,"identity":"ff38a050-ff5d-46c2-9e0e-6a47e6882efe","order_by":4,"name":"Jun Duan","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Duan","suffix":""},{"id":617356974,"identity":"e90cae89-7a52-474c-9373-f6da30b45042","order_by":5,"name":"Ping Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtUlEQVRIiWNgGAWjYDACZjApwcDA3tj48ANpWngONxtLkGadRHqbAA8xCg2O85hJMLZZJG64+bANaJmdnG4DIS2HwVokEjfcTmx7UMCQbGx2gKAW3m0gLblALe0GEgwHErcRr+XmwTYJHtK03GAkUovkYf7PFgznJOpnnkkEBrIBEX7hO38s8QZDWZ0x3/HjDx9+qLCTI6hFAaiA+S8b3J0ElIOAfAOI/EOEylEwCkbBKBi5AAC0qUG4FOzirgAAAABJRU5ErkJggg==","orcid":"","institution":"Xinjiang Production \u0026Construction Corps Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ping","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2026-02-23 03:08:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8942415/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8942415/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106381328,"identity":"33d850b6-943c-4125-9002-1456d5560531","added_by":"auto","created_at":"2026-04-08 05:21:30","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50842,"visible":true,"origin":"","legend":"\u003cp\u003eFlow of patients in the study\u003c/p\u003e","description":"","filename":"Flowofpatientsinthestudy.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8942415/v1/8895f3515d6a223ebc60469c.jpg"},{"id":106404097,"identity":"04f004f7-14f4-4d28-999a-b91e8c1b42a8","added_by":"auto","created_at":"2026-04-08 09:15:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":937115,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8942415/v1/62a58180-85f5-495c-8915-1b3b8ba60862.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Hypomagnesemia on the Prognosis of Elderly Patients with Sepsis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMagnesium is the fourth most abundant element in the human body and the second most abundant cation in human cells. It plays a crucial role in numerous physiological functions, particularly serving as an important cofactor in various enzyme-catalyzed reactions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The normal range of serum magnesium is 1.46\u0026ndash;2.68 mg/dL; thus, hypomagnesemia is defined as a serum magnesium level below 1.46 mg/dL. The incidence of hypomagnesemia is 2% in the general population, 10%\u0026ndash;20% in hospitalized patients, and 50%\u0026ndash;60% in intensive care unit (ICU) patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As an underrecognized electrolyte disorder, hypomagnesemia is closely associated with the pathophysiology of various diseases in critically ill patients, and multiple studies have confirmed its association with poor prognosis in this population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMagnesium ions also play a key role in immune processes: by regulating inflammatory responses and nitric oxide production, they exert a critical effect on the body\u0026rsquo;s resistance to infections [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Sepsis, conversely, is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Current studies have confirmed that sepsis is an independent risk factor for hypomagnesemia in critically ill medical patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, there are relatively few studies on the impact of hypomagnesemia on the prognosis of adult patients with sepsis. Herein, we report this retrospective study to provide a theoretical basis for optimizing future clinical diagnosis and treatment protocols.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on patients with sepsis admitted to the Department of Critical Care Medicine of our hospital from August 2022 to July 2024. According to the Sepsis-3.0 definition, sepsis was defined as \u0026ldquo;life-threatening organ dysfunction (assessed by a Sequential Organ Failure Assessment [SOFA] score\u0026thinsp;\u0026ge;\u0026thinsp;2) caused by a dysregulated host response to infection\u0026rdquo; [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Infection was defined as \u0026ldquo;positive microbial culture results, or clinical manifestations suggestive of infection (even with negative culture results) supported by radiological findings or clinical presentations\u0026rdquo;. Sepsis management was performed using bundled strategies in accordance with the latest clinical guidelines [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This study was approved by the Hospital Ethics Committee (Approval No. : 2022-KY-116), and the requirement for informed consent was waived by the committee due to the retrospective nature of the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and exclusion criteria for cases\u003c/h3\u003e\n\u003cp\u003eMedical records of all patients diagnosed with sepsis at admission were retrospectively reviewed, and only those whose diagnosis was consistent with the Sepsis-3.0 definition were included. \u003cb\u003eInclusion criteria\u003c/b\u003e: (1) Aged 60\u0026ndash;80 years old; (2) Availability of serum magnesium test results within 24 hours of admission; (3) Complete clinical data; (4) Received continuous treatment at our hospital. \u003cb\u003eExclusion criteria\u003c/b\u003e: (1) Aged\u0026thinsp;\u0026lt;\u0026thinsp;60 years or \u0026gt;\u0026thinsp;80 years old; (2) Incomplete test data or clinical information; (3) Discontinued treatment midway (including voluntary discharge against medical advice, transfer to other hospitals, or withdrawal of life-sustaining treatment). The flowchart of case inclusion is shown in Fig.\u0026nbsp;1.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure\u0026nbsp;1.\u003c/b\u003e Flow of patients in the study\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eHypomagnesemia was defined as a serum magnesium level\u0026thinsp;\u0026lt;\u0026thinsp;1.46 mg/dL. Serum magnesium was detected using the xylene blue method on Beckman AU5800 or AU5821 analyzers, which were calibrated monthly with standard reference materials; all samples were fasting serum collected within 24 hours of admission. Collected data included: demographic and clinical baseline characteristics (age, gender, body mass index); comorbidities (hypertension, diabetes mellitus, cerebrovascular disease, coronary heart disease, chronic respiratory disease, chronic liver disease, chronic kidney disease, connective tissue disease); infection sources (central nervous system, lung, abdominal cavity, urinary system, skin and soft tissue, indwelling catheters); clinical characteristics (Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, SOFA score); laboratory characteristics (procalcitonin, platelets, albumin, arterial blood lactic acid, troponin T, and pathogen culture data); organ support measures (use of vasoactive agents, mechanical ventilation, renal replacement therapy); occurrence of in-hospital death. A positive pathogen culture was defined as the growth of at least one microorganism in body fluids (urine, blood, bronchoalveolar lavage fluid, ascites) or biopsy specimens. For patients with negative pathogen cultures, infection was confirmed via metagenomic next-generation sequencing (mNGS) of clinical samples, with a positive result defined as detection of pathogen-specific sequences above the background contamination threshold.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were processed using SPSS 18.0 statistical software. Measurement data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄ \u0026plusmn; s) and compared using analysis of variance (ANOVA). Categorical data were expressed as rates (%) and compared using the chi-square test (χ\u0026sup2; test). Univariate analysis was first performed to screen potential risk factors for in-hospital all-cause mortality, and variables with P\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in univariate analysis were included in multivariate Logistic regression to identify independent risk factors. A value of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eClinical characteristics of patients\u003c/h2\u003e \u003cp\u003eA total of 255 elderly patients were included, among whom 99 (38.8%) had hypomagnesemia. There were no statistically significant differences between the two groups in terms of age, gender, body mass index, comorbidities, or infection sources (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, significant differences were observed in organ support therapy and ICU length of stay between the two groups (both P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The comparison of baseline characteristics between the two groups is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. During hospitalization, 34 patients in the hypomagnesemia group died, with a mortality rate of 34.3%, which was significantly higher than that in the normal magnesium group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of baseline clinical characteristics between the two groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Features\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll patients (n\u0026thinsp;=\u0026thinsp;255)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHypomagnesemia (n\u0026thinsp;=\u0026thinsp;99)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNormal Serum Magnesium (n\u0026thinsp;=\u0026thinsp;156)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen/women, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57/42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88/68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ecomorbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51(32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46(18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22(8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.831\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.647\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic respiratory disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic liver disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.824\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic kidney disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConnective tissue disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSource of infection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.891\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral nervous system, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95(37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56(35.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdomen, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e105(41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65(41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary system, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkin and soft tissue, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndwelling catheter, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive pathogen culture, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90(35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55(35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.984\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPACHE Ⅱ score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSOFA score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcalcitonin (ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet count (\u0026times;10⁹/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104\u0026thinsp;\u0026plusmn;\u0026thinsp;77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u0026thinsp;\u0026plusmn;\u0026thinsp;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121\u0026thinsp;\u0026plusmn;\u0026thinsp;82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin level (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTroponin T (pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArterial blood lactic acid (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVasopressor use, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159(62.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91(91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68(43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMechanical ventilation, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123(48.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(65.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal replacement therapy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72(28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of ICU stay (d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-hospital all-cause mortality (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48(18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePredictors of hypomagnesemia in patients with sepsis\u003c/h3\u003e\n\u003cp\u003eAmong the 255 elderly patients, hypomagnesemia was set as the dependent variable. After univariate analysis followed by multivariate regression analysis, high SOFA score, low platelet count, use of vasoactive agents, and mechanical ventilation were identified as independent predictors of hypomagnesemia in patients with sepsis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Logistic Regression Analysis of Risk Factors for Hypomagnesemia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependent Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegression Coefficient (B)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Error (SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald χ\u0026sup2; Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDegrees of Freedom (df)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOdds Ratio (OR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95% Confidence Interval (95%CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSOFA Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.58\u0026ndash;3.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet Count (\u0026times;10⁹/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.63\u0026ndash;0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVasopressor Use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.01\u0026ndash;4.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMechanical Ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.54\u0026ndash;4.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003ePredictors of all-cause in-hospital mortality in patients\u003c/h3\u003e\n\u003cp\u003eAmong the 255 elderly patients, in-hospital death was set as the dependent variable. Univariate analysis was first conducted, and further multivariate regression analysis revealed that high SOFA score, hypomagnesemia, and mechanical ventilation were independent predictors of in-hospital death in elderly patients with sepsis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of In-Hospital All-Cause Mortality in Adult Patients with Sepsis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegression Coefficient (B)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Error (SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald χ\u0026sup2; Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDegrees of Freedom (df)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOdds Ratio (OR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95% Confidence Interval (95%CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSOFA Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.83\u0026ndash;4.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypomagnesemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.63\u0026ndash;3.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMechanical Ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.01\u0026ndash;4.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eElectrolyte disturbances are the most common issues in patients admitted to the Department of Critical Care Medicine. Hypomagnesemia, which has a high incidence among critically ill patients, is associated with the development of systemic inflammatory response syndrome (SIRS) and even organ dysfunction [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, magnesium deficiency in patients with sepsis may lead to poor prognosis. Our study confirmed that hypomagnesemia is associated with increased in-hospital mortality in elderly patients with sepsis; it is also linked to higher disease severity, lower platelet counts, greater need for organ support, and longer ICU stays. Further analysis revealed that hypomagnesemia is an independent predictor of in-hospital death in elderly patients with sepsis. Thus, during the clinical management of elderly patients with sepsis, emphasis should be placed on monitoring serum magnesium levels and maintaining them within the normal range.\u003c/p\u003e \u003cp\u003eAccurate measurement of magnesium content in the human body is nearly impossible, as 99% of the body\u0026rsquo;s magnesium is primarily located inside cells, and there is currently no simple method to detect total body magnesium. However, in reality, it is the ionic magnesium within cells that holds the greatest physiological significance [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The physiological regulation of magnesium occurs primarily through three mechanisms: intestinal absorption, renal reabsorption/excretion, and exchange with the body\u0026rsquo;s magnesium pool (i.e., bones) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, 38.8% of the subjects had hypomagnesemia, indicating a relatively high incidence of hypomagnesemia in patients with sepsis. This result is consistent with epidemiological surveys, which report that the incidence of hypomagnesemia in elderly critically ill patients ranges from approximately 20% to 60% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], with variations attributed to differences in definition criteria, study populations, and detection methods across different literatures [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. For example, a study by Piano et al. showed that the incidence of hypomagnesemia in elderly critically ill patients was 52.3% [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; other studies have compared serum magnesium levels and found that among adult critically ill patients, the average serum magnesium level in the hypomagnesemia group was approximately 1.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 to 1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0768 mg/dl, while that in the normal magnesium group was 1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12 to 2.038\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23 mg/dl [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite minor differences in specific values, there is a clear clinical consensus: serum magnesium levels in critically ill patients must be monitored to enable timely intervention and improve prognosis.\u003c/p\u003e \u003cp\u003eMagnesium is an essential element in the human body. It not only participates in physiological activities in ionic form but also acts as a key enzymatic cofactor, regulating metabolism, protein synthesis, and the maintenance of cellular integrity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Its complex association with the immune system has been extensively studied, and a large body of evidence confirms that magnesium can regulate both non-specific and specific immune responses [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Animal studies have shown that magnesium deficiency activates the non-specific immune system, impairs the specific immune system, and thereby induces a pro-inflammatory state: at the level of non-specific immunity, magnesium deficiency activates polymorphonuclear leukocytes, increasing phagocytosis and oxidative stress [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], while magnesium supplementation can reduce cytokine production in monocytes via the Toll-like receptor pathway [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]; at the level of specific immunity, magnesium regulates adaptive immunity by influencing the development and proliferation of lymphocytes\u0026mdash;magnesium deficiency in mice leads to early thymic degeneration and reduced T cell counts. Among these processes, the magnesium ion transporter TRPM7 (Transient Receptor Potential Cation Channel Subfamily M Member 7) is crucial for T cell development: its deletion results in insufficient magnesium supply, inhibiting T cell development and triggering apoptosis (this effect can be partially reversed by culturing cells in a high-magnesium medium). In mice with T cell-specific deletion of TRPM7, T lymphocyte development is impaired at the CD4⁻CD8 stage, leading to decreased levels of CD4⁺ and CD4⁺CD8⁺ cells in the thymus [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, extracellular magnesium can regulate the effector function of CD8⁺ T cells through a pathway mediated by the co-stimulatory molecule Lymphocyte Function-Associated Antigen 1 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Based on these mechanisms, even moderate or subclinical magnesium deficiency may promote chronic inflammation by activating leukocytes and macrophages, releasing inflammatory cytokines and acute-phase proteins, and overproducing free radicals.\u003c/p\u003e \u003cp\u003eThe pathophysiological association between serum magnesium and sepsis has not been fully clarified, but existing literature indicates that sepsis is an independent risk factor for hypomagnesemia in critically ill patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The potential mechanisms by which sepsis induces hypomagnesemia include: impaired gastrointestinal function due to inflammatory responses, which affects magnesium absorption; large-volume fluid resuscitation with electrolyte solutions that do not contain magnesium ions; combined metabolic acidosis causing serum magnesium to shift into cells; and impaired renal tubular reabsorption of serum magnesium due to renal function damage [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBoth animal and clinical studies have confirmed the association between hypomagnesemia and adverse progression of sepsis: animal experiments show that hypomagnesemia increases the levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), and enhances the activation of macrophages, neutrophils, and endothelial cells; in contrast, magnesium supplementation can protect mice from lipopolysaccharide (LPS)-induced fatal septic shock by blocking gasdermin-D-induced cell apoptosis [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In clinical studies, hypomagnesemia is significantly associated with an increased incidence of sepsis or septic shock\u0026mdash;a study involving 280 patients with systemic inflammatory response syndrome (SIRS) found that patients with hypomagnesemia (defined as a magnesium level\u0026thinsp;\u0026lt;\u0026thinsp;1.5 mg/dL) at admission had a 1.75-fold higher risk of progressing to septic shock during hospitalization [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A prospective study by Laddhad et al. and a study by Cheungpasitporn et al. both noted that septic patients with hypomagnesemia had higher Sequential Organ Failure Assessment (SOFA) scores and Acute Physiology and Chronic Health Evaluation (APACHE) scores, as well as longer durations of ventilator support and ICU stays [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Tong Fei et al. also confirmed that hypomagnesemia significantly increases mortality in patients with severe sepsis [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], which is consistent with our study\u0026rsquo;s conclusion that \"hypomagnesemia increases mortality in patients with sepsis.\"\u003c/p\u003e \u003cp\u003eGiven that hypomagnesemia exacerbates the poor prognosis of sepsis through mechanisms such as inflammatory activation and immune impairment, magnesium supplementation offers multi-dimensional benefits to elderly patients with sepsis, which are highly aligned with the physiological characteristics of the elderly population and the pathological mechanisms of sepsis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]: in terms of survival prognosis, regardless of whether elderly patients have normal baseline serum magnesium levels, magnesium sulfate supplementation can significantly reduce 28-day all-cause mortality, ICU mortality, and in-hospital mortality. This association remains stable in subgroup analyses involving patients with different comorbidity severities, effectively improving survival outcomes [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]; in terms of organ protection, magnesium supplementation reduces the need for renal replacement therapy, which is particularly important for elderly patients with declining renal function reserves and helps lower the risk of treatment-related complications; in terms of metabolic improvement, as an enzymatic cofactor involved in energy metabolism, magnesium accelerates lactate clearance, shortens lactate clearance time, corrects tissue hypoperfusion and metabolic disorders common in elderly septic patients, and reduces multi-organ damage [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]; furthermore, the anti-inflammatory, antioxidant, and immunomodulatory effects of magnesium can specifically alleviate the excessive inflammatory response and immunosuppressive state caused by immunosenescence in elderly patients, enhancing the body\u0026rsquo;s ability to fight infections [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Although elderly patients often have multiple underlying diseases and complex medication regimens, existing studies confirm that rational magnesium supplementation improves prognosis without additional safety risks, providing important references for clinical treatment.\u003c/p\u003e \u003cp\u003eIn conclusion, hypomagnesemia increases in-hospital all-cause mortality in patients with sepsis and serves as an independent predictor of this outcome. Therefore, in clinical practice, it is necessary to strengthen the monitoring of serum magnesium levels in patients with sepsis, promptly detect hypomagnesemia, and implement early intervention to further improve overall prognosis. However, this study is a single-center retrospective study with a small sample size, and its conclusions still require verification through multi-center randomized controlled studies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSOFA \u0026nbsp; Sequential organ failure assessment\u003c/p\u003e\n\u003cp\u003eICU \u0026nbsp; \u0026nbsp; Intensive care unit\u003c/p\u003e\n\u003cp\u003eAPACHE Ⅱ \u0026nbsp; Acute physiology and chronic health evaluation Ⅱ\u003c/p\u003e\n\u003cp\u003emNGS \u0026nbsp; \u0026nbsp;metagenomic Next-generation sequencing\u003c/p\u003e\n\u003cp\u003eSIRS \u0026nbsp; \u0026nbsp;systemic inflammatory response syndrome\u003c/p\u003e\n\u003cp\u003eTRPM7 \u0026nbsp;Transient Receptor Potential Cation Channel Subfamily M Member 7\u003c/p\u003e\n\u003cp\u003eIL-6 \u0026nbsp; Interleukin-6 \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTNF-α \u0026nbsp; Tumor necrosis factor-α\u003c/p\u003e\n\u003cp\u003eLPS \u0026nbsp; lipopolysaccharide\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003e All the authors consent to the publication of the manuscript and related materials.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e This study adhered to the Declaration of Helsinki. This study was approved by the Hospital Ethics Committee (Approval No.: 2022-KY-116), and the requirement for informed consent was waived by the committee due to the retrospective nature of the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eClinical trial number\u003c/strong\u003e \u003cp\u003enot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNo funding was received for this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Tao Li, Yina Wu, Ping Wang, and the research design was performed by Jun Duan. The first draft of the manuscript was written by Yan Liu, Yunxia Hu, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to express our thanks to all of the recruited participants.\u003c/p\u003e\u003ch2\u003eData availability:\u003c/h2\u003e \u003cp\u003eThe data used to support the findings of this study are included within the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRay E, Mohan K, Ahmad S, et al. Physiology of a Forgotten Electrolyte-Magnesium Disorders. Adv Kidney Dis Health. 2023;30(2):148\u0026ndash;163.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTouyz RM, de Baaij JHF, Hoenderop JGJ. Magnesium Disorders. N Engl J Med. 2024;390(21):1998\u0026ndash;2009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFairley J, Glassford NJ, Zhang L, et al. Magnesium status and magnesium therapy in critically ill patients: A systematic review. J Crit Care. 2015;30(6):1349\u0026ndash;1358.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllgrove J. Physiology of Calcium, Phosphate, Magnesium and Vitamin D. Endocr Dev. 2015;28:7\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinger M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801\u0026ndash;810.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVelissaris D, Karamouzos V, Pierrakos C, et al. Hypomagnesemia in Critically ill Sepsis Patients. J Clin Med Res. 2015;7(12):911\u0026ndash;918.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181\u0026ndash;1247.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZafar MS, Wani JI, Karim R, et al. Significance of serum magnesium levels in critically ill-patients. Int J Appl Basic Med Res. 2014;4(1):34\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKothari M, Wanjari A, Shaikh SM, et al. A Comprehensive Review on Understanding Magnesium Disorders: Pathophysiology, Clinical Manifestations, and Management Strategies. Cureus. 2024;16(9):e68385.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRondanelli M, Faliva MA, Tartara A, et al. An update on magnesium and bone health. Biometals. 2021;34(4):715\u0026ndash;736.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaddhad DS, Hingane V, Patil TR, et al. An assessment of serum magnesium levels in critically ill patients: A prospective observational study. Int J Crit Illn Inj Sci. 2023;13(3):111\u0026ndash;117.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLewińska I, Ścibisz M, Tymecki Ł. Microfluidic paper based analytical device for simultaneous determination of calcium and magnesium ions in human serum. Anal Chim Acta. 2024;1308:342639.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLo Piano F, Corsonello A, Corica F. Magnesium and elderly patient: the explored paths and the ones to be explored: a review. Magnes Res. 2019;32(1):1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaglietti F, Girombelli A, Marelli S, et al. Role of Magnesium in the Intensive Care Unit and Immunomodulation: A Literature Review. Vaccines (Basel). 2023;11(6):1122.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLibako P, Nowacki W, Castiglioni S, et al. Extracellular magnesium and calcium blockers modulate macrophage activity. Magnes Res. 2016;29(1):11\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZusso M, Mercanti G, Belluti F, et al. Phenolic 1,3-diketones attenuate lipopolysaccharide-induced inflammatory response by an alternative magnesium-mediated mechanism. Br J Pharmacol. 2017;174(10):1090\u0026ndash;1103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQiao W, Wong KHM, Shen J, et al. TRPM7 kinase-mediated immunomodulation in macrophage plays a central role in magnesium ion-induced bone regeneration. Nat Commun. 2021;12(1):2885.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026ouml;tscher J, Mart\u0026iacute; I, L\u0026iacute;ndez AA, et al. Magnesium sensing via LFA-1 regulates CD8(+) T cell effector function. Cell. 2022;185(4):585\u0026ndash;602.e29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei Z, Liu Y, Mei X, et al. Circulating micronutrient levels and their association with sepsis susceptibility and severity: a Mendelian randomization study. Front Genet. 2024;15:1353118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhatib N, Ginsberg Y, Ben David C, et al. Magnesium sulphate neuroprotection mechanism is placental mediated by inhibition of inflammation, apoptosis and oxidative stress. Placenta. 2022;127:29\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonuguntla V, Talwar V, Krishna B, et al. Correlation of Serum Magnesium Levels with Clinical Outcome: A Prospective Observational Study in Critically Ill Patients Admitted to a Tertiary Care ICU in India. Indian J Crit Care Med. 2023;27(5):342\u0026ndash;347.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTonai K, Katayama S, Koyama K, et al. Association between hypomagnesemia and serum lactate levels in patients with sepsis: a retrospective observational study. J Anesth Analg Crit Care. 2024;4(1):23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheungpasitporn W, Thongprayoon C, Bathini T, et al. Impact of admission serum magnesium levels on long-term mortality in hospitalized patients. Hosp Pract (1995). 2020;48(2):80\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu WJ, Duan XJ, Liu XZ, et al. Association of magnesium sulfate use with mortality in critically ill patients with sepsis: a retrospective propensity score-matched cohort study. Br J Anaesth. 2023;131(5):861\u0026ndash;870.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSafabakhsh M, Imani H, Shahinfar H, et al. Efficacy of dietary supplements on mortality and clinical outcomes in adults with sepsis and septic shock: A systematic review and network meta-analysis. Clin Nutr. 2024;43(6):1299\u0026ndash;1307.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoormandi A, Khalili H, Mohammadi M, et al. Effect of magnesium supplementation on lactate clearance in critically ill patients with severe sepsis: a randomized clinical trial. Eur J Clin Pharmacol. 2020;76(2):175\u0026ndash;184.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePranskunas A, Vellinga NA, Pilvinis V, et al. Microcirculatory changes during open label magnesium sulphate infusion in patients with severe sepsis and septic shock. BMC Anesthesiol. 2011;11:12.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hypomagnesemia, Elderly, Sepsis, In-hospital All-cause Mortality","lastPublishedDoi":"10.21203/rs.3.rs-8942415/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8942415/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate the association between hypomagnesemia and in-hospital all-cause mortality in elderly patients with sepsis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was performed on elderly patients (60\u0026ndash;80 years old) with sepsis admitted to the Department of Critical Care Medicine of our hospital from August 2022 to July 2024. Eligible patients were divided into the hypomagnesemia group (serum magnesium\u0026thinsp;\u0026lt;\u0026thinsp;1.46 mg/dL) and the normal magnesium group based on their serum magnesium levels at admission. The mortality difference between the two groups was compared, and univariate analysis was first conducted followed by multivariate Logistic regression to identify independent risk factors for in-hospital mortality.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 255 elderly patients were included, with 99 in the hypomagnesemia group. The mortality rate of the hypomagnesemia group was 34.3%, which was significantly higher than that of the normal magnesium group (9.0%), with a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). High Sequential Organ Failure Assessment (SOFA) score, mechanical ventilation, and hypomagnesemia were independent risk factors for in-hospital all-cause mortality in elderly patients with sepsis (OR\u0026thinsp;=\u0026thinsp;2.63, 2.14, 3.01, all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eHypomagnesemia is an independent risk factor for in-hospital all-cause mortality in elderly patients with sepsis. Attention should be paid to maintaining normal serum magnesium levels during the management of these patients.\u003c/p\u003e","manuscriptTitle":"The Impact of Hypomagnesemia on the Prognosis of Elderly Patients with Sepsis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-08 05:21:22","doi":"10.21203/rs.3.rs-8942415/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-12T14:49:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-02T20:53:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277229079718092474864542426933317832545","date":"2026-04-01T17:08:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"150712764671591181446957796486616088821","date":"2026-03-30T04:57:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-28T20:46:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161386178531027295547729297947026861382","date":"2026-03-28T19:43:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-28T18:23:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100534410323935061317053143753480491815","date":"2026-03-28T18:13:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"94038887919692400228942105704451523975","date":"2026-03-28T18:12:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-28T17:28:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-02T05:03:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-27T07:35:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Medical Research","date":"2026-02-27T02:02:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f8edbb80-568d-437d-adb1-af970bb2ee3f","owner":[],"postedDate":"April 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T05:21:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-08 05:21:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8942415","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8942415","identity":"rs-8942415","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}