高血清镁水平与急性呼吸窘迫综合征患者死亡率的关联性

Association of serum magnesium levels with 30‐day mortality in patients with acute respiratory distress syndrome

摘要

目的：探讨急性呼吸窘迫综合征（ARDS）患者入住重症监护病房（ICU）时的血清镁水平与30天全因死亡率的关系。方法：基于MIMIC-Ⅳ v3.1数据库，共纳入1 107例首次诊断为ARDS的成人患者。按入院血清镁五分位数分组，主要结局为30天全因死亡率。采用Kaplan-Meier曲线与log-rank检验比较组间生存差异，应用Cox比例风险回归模型评估血清镁与死亡的独立关联，并通过限制性立方样条（RCS）分析发现线性关联。结果：Kaplan-Meier分析显示，血清镁最高分位组（Q5）生存率最低（P=0.008 9）。多因素Cox回归证实，高血清镁水平是死亡的独立危险因素（HR=1.39，95%CI：1.10~1.76，P=0.006）。RCS分析提示死亡风险随血清镁升高呈近似线性增加（总体关联P=0.016）。亚组分析结果一致。结论：ARDS患者入院时高血清镁水平与30天全因死亡风险增加独立相关，可作为风险分层的潜在生物标志物。

Abstract

Objective: To investigate the association between serum magnesium levels at ICU admission and 30-day all-cause mortality in patients with acute respiratory distress syndrome (ARDS). Methods: This study was based on the MIMIC-Ⅳ v3.1 database. A total of 1 107 adult patients with a first-time diagnosis of ARDS were enrolled. Patients were divided into groups according to the quintiles of their initial serum magnesium levels. The primary outcome was 30-day all-cause mortality. Kaplan-Meier curves with the log-rank test were used to compare survival differences between groups. A Cox proportional hazards regression model was employed to assess the independent association between serum magnesium and mortality. A restricted cubic spline (RCS) model was applied and revealed a linear association. Results: Kaplan-Meier analysis showed that the group with the highest serum magnesium quintile (Q5) had the lowest survival rate (P=0.008 9). Multivariable Cox regression confirmed that a higher serum magnesium level was an independent risk factor for mortality (HR=1.39, 95%CI: 1.10-1.76, P=0.006). RCS analysis indicated an approximately linear increase in mortality risk with rising serum magnesium levels (P for overall association=0.016). Subgroup analyses yielded consistent results. Conclusion: A higher serum magnesium level at admission is independently associated with an increased risk of 30-day all-cause mortality in ARDS patients, suggesting its potential role as a biomarker for risk stratification.

关键词

急性呼吸窘迫综合征 / 血清镁 / 死亡率 / 预后

Key words

Acute Respiratory Distress Syndrome / Serum Magnesium / Mortality / Prognosis

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基金资助

新发突发与重大传染病防控国家科技重大专项(2025ZD01902600)

北京医卫健康公益基金会(YWJKJJHKYJJ-B2024072201)

武汉大学研究生导师育人方式创新项目(413200144)

中央高校基本科研业务费专项资金资助(2042025YXA010)