Prognostic value of Ionised Magnesium in predicting outcome of adult patients with sepsis attending the emergency medicine departments in Tanzania

Abstract

ABSTRACT Background: Serum Lactate is used as an indicator of sepsis in critically ill patients and is alternatively compared with qSOFA. Magnesium is the second most abundant intracellular ion which plays an essential role in enhancing host immunity against sepsis. To date, there is no literature from Tanzania evaluating the association between ionized magnesium and mortality from sepsis. This study aimed to determine the performance of ionized magnesium in predicting the mortality of patients with sepsis attending emergency medicine department in Tanzania. Methodology: From February 2024 to April 2024 314 patients were consecutively enrolled at the emergency medicine department (EMD) of Muhimbili National Hospital (MNH) and Shree Hindu Mandal Hospital (SHMH) in Tanzania prospectively. Adults (≥18 years old) suspected having sepsis who met the qSOFA score≥2 were included and followed up for 24 hours to assess mortality. The primary outcome was the prognostic ability of ionized magnesium to predict 24 hours mortality at the EMD. At EMD ionized (iMg) and total magnesium (tMg) 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. Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) were evaluated of hypermagnesemia and hypomagnesemia to determine their ability to predict 24 hour’s mortality among critically ill adult patients with sepsis. Results: 314 patients met the inclusion criteria and were enrolled. iMg had an AUC=0.549 (95% CI, 0.439-0.659). Sensitivity and specificity of iMg were 66.67% (95% CI, 46.50-86.83) and 41.05% (95% CI,35.34-46.76) respectively. Hypermagnesemia was 40.9% sensitive and 73.2% specific whereas hypomagnesemia was 4.5% sensitive and 78.7% specific. Conclusion: Our study showed that total magnesium had the ability to predict mortality in the emergency medicine departments. While ionised magnesium had no prognostic value among adult patients with sepsis in Tanzania. However, lack of standardization of diagnostic reference levels was the reason for the seldom identification of iMg in sub-Saharan Africa.