PROGNOSTIC VALUE OF IONISED MAGNESIUM IN PREDICTING OUTCOME OF ADULT PATIENTS WITH SEPSIS ATTENDING THE EMERGENCY MEDICINE DEPARTMENTS IN TANZANIA

Abstract

Background: Serum lactate is an indicator of sepsis in critically ill patients. Magnesium (Mg) is the second most abundant intracellular ion enhancing host immunity. Currently no research from Tanzania investigating the relationship between sepsis-related mortality and ionised magnesium exists. This study aimed to determine the performance of ionised magnesium in predicting the mortality of patients with sepsis attending emergency departments in Tanzania.

Methodology: This prospective cohort study was conducted at the emergency departments of Muhimbili National Hospital and Shree Hindu Mandal Hospital in Tanzania from February to April 2024. Patients≥18 years who met the qSOFA score≥2 were included. 308 patients were enrolled. Categorical data was displayed as proportion and continuous as mean+SD or median. Ionised and total magnesium levels were classified as normal and abnormal based on cut-off values of 0.4-0.6 mmol/L and 0.7-1.0 mmol/L, respectively. The test's predictive power for mortality, sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) were evaluated.

Results: 314 patients met the inclusion criteria. Ionised Mg had an AUC=0.549 (95% CI, 0.439-0.659) with an ability to predict mortality in 7.6% (p-value 0.379). Total magnesium had an ability to predict mortality in 42.86% patients, and correctly identifies those who did not die 51.93% of the time with the AUC=0.642(95% CI, 0.538-0.746 ,p-value=0.008). The sensitivity and specificity of ionized magnesium on prediction of mortality among adult patients with sepsis were 66.67% (95% CI, 46.50-86.83) and 41.05% (95% CI,35.34-46.76) respectively.

Conclusion: According to this study, the uncommon detection of iMg in clinical practice is caused by a lack of standardization of diagnostic reference levels since no information was available depicting the relationship between ionized and total magnesium concentrations in the sub-Saharan Africa and total magnesium acts as a good indicator of sepsis.

How is the research going to impact African emergency care

This study provides an opportunity to understand whether total magnesium or ionized magnesium is a good prognostic marker of mortality in patients with sepsis at the department of emergency medicine in Tanzania. Understanding the performance of ionized magnesium in predicting the mortality of patients with sepsis helps provide an alternative prediction that no previous studies of this kind have been carried out in Tanzania and sub-Saharan Africa. In addition, this study also determines the relationship between patient outcomes in terms of all-cause mortality and the emergency and urgent care that was offered at the EMD. Furthermore, this study assists in locating potential gaps in patient as far as ionized magnesium is concerned.