Hypomagnesemia is associated with increased mortality in the short-term but not the long-term in community-acquired pneumonia patients with type 2 diabetes

Introduction: The present study explored the relationship between hypomagnesemia and outcome in community-acquired pneumonia (CAP) patients with type 2 diabetes mellitus (T2DM). Methods: The study was a retrospective cohort study, conducted on adult CAP patients with T2DM at The First Hospital of Qinhuangdao between January 2015 and December 2018. The primary outcome was all-cause deaths. Results: In total, 480 CAP inpatients with T2DM were enrolled, and 71 patients (14.8%) had hypomagnesemia on admission. After one month and three months of follow-up, the hypomagnesemia group had a higher mortality rate than the normal magnesium group (p<0.05). After six months of follow-up, the mortality rate remained higher in the hypomagnesemia group, however, this was not statistically significant (χ²=2.799, p=0.094). After 12 months and 24 months of follow-up, the mortality rates were similar between the hypomagnesemia and normal magnesium groups (p<0.05). Based on multiple logistic regression analysis, hypomagnesemia was an independent risk factor for one-monthmortality(OR=3.858,95% CI: 1.637~9.088, p=0.002), three-month mortality (OR=3.083, 95% CI: 1.434~6.627, p=0.004) and six-month mortality (OR=2.551, 95% CI: 1.209~5.383, p=0.014). Conclusions: Hypomagnesemia is common in CAP inpatients with T2DM. Moreover, in these patients, hypomagnesemia at admission is associated with increased mortality in the short-term but not the long-term.

Age, Pulse, Urea, and Albumin Score: A Tool for Predicting the Short-Term and Long-Term Outcomes of Community-Acquired Pneumonia Patients With Diabetes.

Objective: The predictive performances of CURB-65 and pneumonia severity index (PSI) were poor in patients with diabetes. This study aimed to develop a tool for predicting the short-term and long-term outcomes of CAP in patients with diabetes. Methods: A retrospective study was conducted on 531 CAP patients with type 2 diabetes. The short-term outcome was in-hospital mortality. The long-term outcome was 24-month all-cause death. The APUA score was calculated according to the levels of Age (0-2 points), Pulse (0-2 points), Urea (0-2 points), and Albumin (0-4 points). The area under curves (AUCs) were used to evaluate the abilities of the APUA score for predicting short-term outcomes. Cox regression models were used for modeling relationships between the APUA score and 24-month mortality. Results: The AUC of the APUA score for predicting in-hospital mortality was 0.807 in patients with type 2 diabetes (P<0.001). The AUC of the APUA score was higher than the AUCs of CURB-65 and PSI class (P<0.05). The long-term mortality increased with the risk stratification of the APUA score (low-risk group (0-1 points) 11.5%, intermediate risk group (2-4 points) 16.9%, high risk group (≥5 points) 28.8%, P<0.05). Compared with patients in the low-risk group, patients in the high-risk group had significantly increased risk of long-term death, HR (95%CI) was 2.093 (1.041~4.208, P=0.038). Conclusion: The APUA score is a simple and accurate tool for predicting short-term and long-term outcomes of CAP patients with diabetes.

Hospital-acquired dysmagnesemia and mortality in critically ill patients: data from MIMIC-III database.

This study aimed to determine the relationship between hospital-acquired dysmagnesemia and in-hospital mortality in critically ill patients. A retrospective cohort study was conducted on critically ill patients who had normal serum magnesium levels on admission. Data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care III database. The normal range of serum magnesium was 1.6-2.6 mg/dL. In-hospital serum magnesium levels were categorized based on the occurrence of hospital-acquired hypomagnesemia and hypermagnesemia. Hospital-acquired hypomagnesemia and hypermagnesemia in the same patient were defined as a patient with the lowest level of serum magnesium of <1.6 mg/dL and the highest level of serum magnesium of >2.6 mg/dL, respectively. The in-hospital outcomes were collected. The findings revealed that 27.2% of patients developed hospital-acquired dysmagnesemia. In-hospital mortalities were 8.8% in patients with persistently normal serum magnesium levels, 12.2% in patients with hospital-acquired hypomagnesemia only, 18.4% in patients with hospital-acquired hypermagnesemia only, and 20.6% in patients with both hospital-acquired hypomagnesemia and hypermagnesemia. Compared to patients with persistently normal serum magnesium in hospital, those with hospital-acquired hypermagnesemia only [odds ratio (OR) = 1.346, P < 0.001] and those with both hospital-acquired hypomagnesemia and hypermagnesemia (OR = 1.333, P = 0.001) were significantly associated with higher in-hospital mortality. Hospital-acquired dysmagnesemia was common among critically ill patients. Hospital-acquired dysmagnesemia, especially hospital-acquired hypermagnesemia, was significantly associated with increased in-hospital mortality in critically ill patients.

The association between abnormal serum magnesium levels and prognosis of elderly patients with community-acquired pneumonia.

To investigate the association between abnormal serum magnesium levels and the prognosis of elderly patients with community-acquired pneumonia (CAP). Methods: A retrospective study was conducted on 1381 elderly patients with CAP in the First Hospital of Qinhuangdao between January 2015 and December 2018. Serum magnesium concentrations in the range of 0.75-1.25 mmol/L were defined as normal. Patients were assigned into normal, hypomagnesemia, and hypermagnesemia groups. The primary outcome was in-hospital mortality, indicating whether a patient died at the time of discharge from the hospital. The percentages of respiratory failure and mechanical ventilation were 18.6% and 10.6 % in the normal group, 29% and 16.5 % in the hypomagnesemia, and 42.9% and 35.7% in the hypermagnesemia groups. The occurrence of shock was 8.5% and 4.5% in the hypomagnesemia group and the normal group. The percentages of the length of stay at ICU were 14.9%, 18.8%, and 57.1% in the hypomagnesemia, normal, and hypermagnesemia groups. The in-hospital mortality rate was 5.3%, 9.1%, and 35.7% in the normal, hypomagnesemia, and hypermagnesemia groups, respectively. The results of univariate analysis showed that the in-hospital mortality in the hypomagnesemia group was 1.790 (95% confidence interval (CI): 1.009∼3.176, P=0.046) times higher than that in the normal group; in the hypermagnesemia group, it was 9.947 (95% CI: 3.238-30.556, P<0.001) times higher than that in the normal group. The results of multivariate logistic regression analysis showed that after adjusting for gender, age, diabetes, heart failure, cerebrovascular disease, cancer, estimated glomerular filtration rate (eGFR), glucose, and CURB-65 score, in the hypomagnesemia group, the in-hospital mortality was 1.746 (95% confidence interval (CI): 0.956∼3.186, P=0.070) times higher than that in the normal group, and 5.689 (95% CI: 1.583- 20.446, P=0.008) times higher in the hypermagnesemia group than that in the normal group. Abnormal serum magnesium levels are strongly associated with in-hospital mortality in elderly patients with CAP. The measurement of serum magnesium levels in elderly patients with CAP at admission may assist clinicians to determine the prognosis of such patients.

Incorporating Sulfur Inside the Pores of Carbons for Advanced Lithium-Sulfur Batteries: An Electrolysis Approach.

We have developed an electrolysis approach that allows effective and uniform incorporation of sulfur inside the micropores of carbon nanosheets for advanced lithium-sulfur batteries. The sulfur-carbon hybrid can be prepared with a 70 wt % sulfur loading, in which no nonconductive sulfur agglomerations are formed. Because the incorporated sulfur is electrically connected to the carbon matrix in nature, the hybrid cathode shows excellent electrochemical performance, including a high reversible capacity, good rate capability, and good cycling stability, as compared to one prepared using the popular melt-diffusion method.