The role of serum magnesium in the prediction of acute kidney injury after total aortic arch replacement: A prospective observational study.

IF 2 4区医学 Q4 BIOCHEMISTRY & MOLECULAR BIOLOGY Journal of Medical Biochemistry Pub Date : 2024-06-15 DOI:10.5937/jomb0-48779

Xinyi Jiang, Ziyun Li, Chixing Pan, Heng Fang, Wang Xu, Zeling Chen, Junjiang Zhu, Linling He, Miaoxian Fang, Chunbo Chen

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Abstract

Background: Considerable morbidity and death are associated with acute kidney damage (AKI) following total aortic arch replacement (TAAR). The relationship between AKI following TAAR and serum magnesium levels remains unknown. The intention of this research was to access the predictive value of serum magnesium levels on admission to the Cardiovascular Surgical Intensive Care Unit (CSICU) for AKI in patients receiving TAAR.

Methods: From May 2018 to January 2020, a prospective, observational study was performed in the Guangdong Provincial People's Hospital CSICU. Patients accepting TAAR admitted to the CSICU were studied. The Kidney Disease: Improving Global Outcomes (KDIGO) definition of serum creatinine was used to define AKI, and KDIGO stages two or three were used to characterize severe AKI. Multivariable logistic regression and area under the curve receiver-operator characteristic curve (AUC-ROC) analysis were conducted to assess the predictive capability of the serum magnesium for AKI detection. Finally, the prediction model for AKI was established and internally validated.

Results: Of the 396 enrolled patients, AKI occurred in 315 (79.5%) patients, including 154 (38.8%) patients with severe AKI. Serum magnesium levels were independently related to the postoperative AKI and severe AKI (both, P < 0.001), and AUC-ROCs for predicting AKI and severe AKI were 0.707 and 0.695, respectively. Across increasing quartiles of serum magnesium, the multivariable-adjusted odds ratios (95% confidence intervals) of postoperative AKI were 1.00 (reference), 1.04 (0.50-2.82), 1.20 (0.56-2.56), and 6.19 (2.02-23.91) (P for Trend < 0.001). When serum magnesium was included to a baseline model with established risk factors, AUC-ROC (0.833 vs 0.808, P = 0.050), reclassification (P < 0.001), and discrimination (P = 0.002) were further improved.

Conclusions: Serum magnesium levels on admission are an independent predictor of AKI. In TAAR patients, elevated serum magnesium levels were linked to an increased risk of AKI. In addition, the established risk factor model for AKI can be considerably improved by the addition of serum magnesium in TAAR patients hospitalized in the CSICU.

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血清镁在预测全主动脉弓置换术后急性肾损伤中的作用：前瞻性观察研究。

背景：全主动脉弓置换术（TAAR）后急性肾损伤（AKI）会导致大量的发病和死亡。全主动脉弓置换术后急性肾损伤（AKI）与血清镁水平之间的关系尚不清楚。本研究的目的是了解心血管外科重症监护室（CSICU）收治接受TAAR患者时血清镁水平对AKI的预测价值：2018年5月至2020年1月，在广东省人民医院CSICU开展了一项前瞻性观察研究。研究对象为CSICU收治的接受TAAR的患者。肾脏疾病：KDIGO）定义的血清肌酐定义为AKI，KDIGO二期或三期定义为重度AKI。为评估血清镁对 AKI 检测的预测能力，进行了多变量逻辑回归和曲线下接收者特征曲线面积（AUC-ROC）分析。最后，建立了 AKI 预测模型并进行了内部验证：结果：在 396 例入选患者中，315 例（79.5%）发生了 AKI，其中包括 154 例（38.8%）重度 AKI 患者。血清镁水平与术后 AKI 和严重 AKI 独立相关（均为 P <0.001），预测 AKI 和严重 AKI 的 AUC-ROC 分别为 0.707 和 0.695。在血清镁不断增加的四分位数中，术后 AKI 的多变量调整几率比（95% 置信区间）分别为 1.00（参考值）、1.04（0.50-2.82）、1.20（0.56-2.56）和 6.19（2.02-23.91）（趋势 P <0.001）。当血清镁被纳入到具有既定风险因素的基线模型中时，AUC-ROC（0.833 vs 0.808，P = 0.050）、再分类（P < 0.001）和区分度（P = 0.002）得到进一步改善：结论：入院时的血清镁水平是预测 AKI 的独立指标。在 TAAR 患者中，血清镁水平升高与 AKI 风险增加有关。此外，在 CSICU 住院的 TAAR 患者中加入血清镁可大大改善已建立的 AKI 风险因素模型。

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来源期刊

Journal of Medical Biochemistry BIOCHEMISTRY & MOLECULAR BIOLOGY-

CiteScore

3.00

自引率

12.00%

发文量

审稿时长

>12 weeks

期刊介绍： The JOURNAL OF MEDICAL BIOCHEMISTRY (J MED BIOCHEM) is the official journal of the Society of Medical Biochemists of Serbia with international peer-review. Papers are independently reviewed by at least two reviewers selected by the Editors as Blind Peer Reviews. The Journal of Medical Biochemistry is published quarterly. The Journal publishes original scientific and specialized articles on all aspects of clinical and medical biochemistry, molecular medicine, clinical hematology and coagulation, clinical immunology and autoimmunity, clinical microbiology, virology, clinical genomics and molecular biology, genetic epidemiology, drug measurement, evaluation of diagnostic markers, new reagents and laboratory equipment, reference materials and methods, reference values, laboratory organization, automation, quality control, clinical metrology, all related scientific disciplines where chemistry, biochemistry, molecular biology and immunochemistry deal with the study of normal and pathologic processes in human beings.