Sepsisli Kritik Hastalarda Erken Karaciğer Disfonksiyonunun Bir Göstergesi Olarak Hipomagnezemi

Amaç: Karaciğer disfonksiyonu, sepsiste gelişen inflamasyon ve hipoperfüzyonun neden olduğu erken bir bulgudur. Magnezyum eksikliği, immün strese karşı aşırı bir yanıta ve sepsiste inflamatuar doku hasarına katkıda bulunabilir. Bu çalışmada, sepsisli hastalarda serum magnezyum düzeyleri ile erken karaciğer disfonksiyonu (early liver dysfunction, ELD) arasındaki ilişkinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Sepsis gelişen 142 hasta karaciğer fonksiyonlarına göre ardışık organ yetmezliği değerlendirme (sequential organ failure assessment, SOFA) karaciğer alt skoru <2 olanlar (Non-ELD, n=72) ve SOFA karaciğer alt skoru ≥2 olanlar (ELD, n=70) olmak üzere iki gruba ayrıldı. Akut fizyoloji ve kronik sağlık değerlendirmesi (acute physiology and chronic health evaluation, APACHE) II skoru ve SOFA skoru dahil olmak üzere hastalık şiddeti, biyokimyasal belirleme ve mikrobiyolojik kültürler değerlendirildi. Bulgular: ELD hastalarının APACHE II ve toplam SOFA skorları ELD olmayan hastalara göre daha yüksek iken, PaO2/FiO2 oranları anlamlı derecede düşüktü (her ikisi için p<0,001). Hipomagnezemi ve hipoalbüminemi ELD ile bağımsız şekilde ilişkiliydi (sırasıyla, OR: 6,55; %95 GA: 2,62-16,36 ve OR: 4,62; %95 GA: 1,35-15,84). ELD’yi öngörmede, serum magnezyum ve albümini için eğri altındaki alan sırasıyla 0,81 (%95 GA: 0,74-0,89; p<0,001) ve 0,70 (%95 GA: 0,61-0,79; p<0,001) idi. Tüm septik hastalardaki ölüm oranı, hipomagnezemi için %35,0 ve normomagnezemi için %25,6 idi (p=0,065). ELD hastalarındaki ölüm oranı hipomagnezemi için %34,1 ve normomagnezemi için %30,7 idi (p=0,415). Sonuç: Magnezyum düzeylerindeki azalma, sepsisli kritik hastalarda artmış ELD oranları ile ilişkiliydi. Kabuldeki hipomagnezemi ne tüm sepsisli hastalarda, ne de ELD gelişenlerde mortaliteyi olumsuz etkilemedi.

Anahtar Kelimeler:

Kritik hasta, hipomağnezemi, karaciğer, mortalite, sepsis

Hypomagnesemia as a Predictor of Early Liver Dysfunction in Critically Ill Patients with Sepsis

Aim: Liver dysfunction is an early finding caused by the inflammation and hypoperfusion developed in sepsis. Magnesium deficiency may contribute to an excessive response to immune stress and inflammatory tissue damage in sepsis. This study aimed to evaluate the relationship between serum magnesium levels and early liver dysfunction (ELD) in patients with sepsis. Material and Methods: 142 patients who developed sepsis were divided into two groups according to their liver function, as sequential organ failure assessment (SOFA) hepatic subscore <2 (Non-ELD, n=72) and SOFA hepatic subscore ≥2 (ELD, n=70). The disease severity, including the acute physiology and chronic health evaluation (APACHE) II score and the SOFA score, biochemical determination, and microbiological cultures were evaluated. Results: ELD patients presented APACHE II and total SOFA scores higher than Non-ELD patients, while PaO2/FiO2 ratios were significantly lower (both p<0.001). Hypomagnesemia and hypoalbuminemia were independently associated with ELD (OR: 6.55, 95% CI: 2.62-16.36, and OR: 4.62, 95% CI: 1.35-15.84, respectively). To predict ELD, the area under the curve was 0.81 (95% CI: 0.74-0.89, p<0.001) and 0.70 (95% CI, 0.61-0.79; p<0.001) for serum magnesium and albumin, respectively. The mortality rate in all septic patients was 35.0% for hypomagnesemia and 25.6% for normomagnesemia (p=0.065). The mortality rate in ELD patients was 34.1% for hypomagnesemia and 30.7% for normomagnesemia (p=0.415). Conclusion: The reduction of magnesium levels was associated with increased rates of ELD in critically ill patients with sepsis. Admission hypomagnesemia did not adversely affect mortality neither in all sepsis patients nor in those who developed ELD.

Keywords:

Critically ill, hypomagnesemia, liver, mortality, sepsis,

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