The magnesium global network (MaGNet) to promote research on magnesium in diseases focusing on covid-19

Lower Serum Magnesium Is Associated with Mortality in Severe COVID-19: A Secondary Analysis of a Randomized Trial

Many abnormalities in laboratory tests have been described in severe coronavirus disease (COVID-19), but most of them probably just reflect the degree of organ dysfunction and are not true risk factors for death. The present study is a secondary analysis of a clinical trial carried out in patients hospitalized due to severe COVID-19 (ClinicalTrials.gov identifier No. NCT04443673). We explored the association of clinical laboratory tests and serum cytokines with death in COVID-19 patients, either considering only the initial measurement obtained shortly after the patient's arrival at the emergency room, or by means of the weighted average of all measurements during the entire hospitalization. The study included 56 patients with a mean age of 58.6 years (range from 31.8 to 86.2 years), with a fatality rate of 58.9% (33 patients). Among initial laboratory tests, only mean corpuscular volume (MCV), erythrocyte count, serum magnesium, and age showed a trend (p < 0.10, univariable logistic regression) for an association with a fatal outcome. However, in the multivariable logistic regression, only MCV and magnesium remained associated with death, with adjusted odds ratios (95% confidence intervals) of 1.253 (1.047-1.501, p = 0.014) and 0.091 (0.010-0.798, p = 0.03), respectively. Serum magnesium tended to decrease during the hospital stay in both groups, survivors and non-survivors. Compared with survivors, patients who died had a higher weighted average of urea, blood urea nitrogen (BUN), procalcitonin, MCV, neutrophils, neutrophil/lymphocyte ratio, fibrinogen/albumin ratio, C-reactive protein/albumin ratio, BUN/albumin ratio, IL-6, and IL-10, as well as decreased weighted average of albumin, lymphocytes, and monocytes, among others. In conclusion, patients with severe COVID-19 who had lower serum magnesium on their arrival at the emergency room were more prone to die. On the other hand, serum magnesium tended to decrease during the patients' hospital stay, independently of the outcome.Trial Registration: ClinicalTrials.gov NCT04443673.

The Impact of Low Serum Magnesium Levels on COVID-19 Severity and Potential Therapeutic Benefits of Magnesium Supplementation: A Systematic Review

In this review, our objective was to analyze the association between serum magnesium (Mg) levels, Mg supplementation, and coronavirus disease 2019 (COVID-19) outcomes. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching major databases until February 2023. Twenty-six studies (11,363 patients) were included: 22 examining serum Mg levels (8474 patients) and four investigating Mg supplementations (2889 patients). Most studies indicated an association between lower serum Mg levels and increased COVID-19 severity, including higher mortality rates and prolonged recovery periods. Critical patients demonstrated significantly lower Mg levels compared to moderate/severe cases. However, some studies reported conflicting findings, with hypermagnesemia also associated with poor outcomes in specific patient populations. Regarding supplementation, higher dietary Mg intake correlated with shorter hospitalization duration and faster recovery. Mg supplementation exceeding 450 mg showed potential benefits, including increased antibody titers in pregnant women and reduced oxygen support requirements in elderly patients when combined with vitamins D and B12. While evidence suggests a potential relationship between Mg status and COVID-19 outcomes, findings are heterogeneous. Further investigation through well-designed clinical trials is required to gain deeper insights into the role of Mg in COVID-19 pathophysiology and the therapeutic potential of Mg supplementation.

The relevance of magnesium homeostasis in COVID-19

PURPOSE

In less than one and a half year, the COVID-19 pandemic has nearly brought to a collapse our health care and economic systems. The scientific research community has concentrated all possible efforts to understand the pathogenesis of this complex disease, and several groups have recently emphasized recommendations for nutritional support in COVID-19 patients. In this scoping review, we aim at encouraging a deeper appreciation of magnesium in clinical nutrition, in view of the vital role of magnesium and the numerous links between the pathophysiology of SARS-CoV-2 infection and magnesium-dependent functions.

METHODS

By searching PubMed and Google Scholar from 1990 to date, we review existing evidence from experimental and clinical studies on the role of magnesium in chronic non-communicable diseases and infectious diseases, and we focus on recent reports of alterations of magnesium homeostasis in COVID-19 patients and their association with disease outcomes. Importantly, we conduct a census on ongoing clinical trials specifically dedicated to disclosing the role of magnesium in COVID-19.

RESULTS

Despite many methodological limitations, existing data seem to corroborate an association between deranged magnesium homeostasis and COVID-19, and call for further and better studies to explore the prophylactic or therapeutic potential of magnesium supplementation.

CONCLUSION

We propose to reconsider the relevance of magnesium, frequently overlooked in clinical practice. Therefore, magnesemia should be monitored and, in case of imbalanced magnesium homeostasis, an appropriate nutritional regimen or supplementation might contribute to protect against SARS-CoV-2 infection, reduce severity of COVID-19 symptoms and facilitate the recovery after the acute phase.