Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome

Donogh Maguire, David P. Ross, Dinesh Talwar, Ewan Forrest, Hina Naz Abbasi, John-Paul Leach, Marylynne Woods, Luke Y. Zhu, Scott Dickson, Tong Kwok, Isla Waterson, George Benson, Benjamin Scally, David Young, Donald C. McMillan

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Abstract

Background: In 2014, the WHO reported that 6% of all deaths were attributable to excess alcohol consumption. The aim of the present study was to examine the relationship between serum magnesium concentrations and mortality in patients with alcohol withdrawal syndrome (AWS). Materials and methods: A retrospective review of 700 patients with documented evidence of previous AWS indicating a requirement for benzodiazepine prophylaxis or evidence of alcohol withdrawal syndrome between November 2014 and March 2015. Results: Of 380 patients included in the sample analysis, 64 (17%) were dead at 1 year following the time of treatment for AWS. The majority of patients had been prescribed thiamine (77%) and a proton pump inhibitor (66%). In contrast, the majority of patients had low circulating magnesium concentrations (<0.75 mmol/L) (64%) and had not been prescribed magnesium (90%). The median age of death at one year was 55 years (P = 0.002). On univariate analysis, age (P < 0.05), GMAWS (P < 0.05), BDZ (P < 0.05), bilirubin (P < 0.001), alkaline phosphatase (P < 0.001), albumin (P < 0.001), CRP (P < 0.05), AST:ALT ratio >2 (P < 0.001), sodium (P < 0.05), magnesium (P < 0.001), platelets (P < 0.05) and the use of proton pump inhibitor medication (P < 0.001) were associated with death at 1 year. On multivariate binary logistic regression analysis, age > 50 years (OR 3.37, 95% CI 1.52-7.48, P < 0.01), AST:ALT ratio >2 (OR 3.10, 95% CI 1.38-6.94, P < 0.01) and magnesium < 0.75 mmol/L (OR 4.11, 95% CI 1.3-12.8, P < 0.05) remained independently associated with death at 1 year. Conclusion: Overall, 1-year mortality was significantly higher among those patients who were magnesium deficient (<0.75 mmol/L) when compared to those who were replete (≥0.75 mmol/L; P < 0.001).

Original languageEnglish
Article numbere13152
Number of pages8
JournalEuropean Journal of Clinical Investigation
Volume49
Issue number9
Early online date19 Jun 2019
DOIs
Publication statusPublished - 1 Sep 2019

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Magnesium
Alcohols
Mortality
Serum
Proton Pump Inhibitors
Thiamine
Benzodiazepines
Alcohol Drinking

Keywords

  • excess alcohol consumption
  • alcohol withdrawal syndrome
  • alcohol related deaths

Cite this

Maguire, D., Ross, D. P., Talwar, D., Forrest, E., Abbasi, H. N., Leach, J-P., ... McMillan, D. C. (2019). Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome. European Journal of Clinical Investigation, 49(9), [e13152]. https://doi.org/10.1111/eci.13152
Maguire, Donogh ; Ross, David P. ; Talwar, Dinesh ; Forrest, Ewan ; Abbasi, Hina Naz ; Leach, John-Paul ; Woods, Marylynne ; Zhu, Luke Y. ; Dickson, Scott ; Kwok, Tong ; Waterson, Isla ; Benson, George ; Scally, Benjamin ; Young, David ; McMillan, Donald C. / Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome. In: European Journal of Clinical Investigation. 2019 ; Vol. 49, No. 9.
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title = "Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome",
abstract = "Background: In 2014, the WHO reported that 6{\%} of all deaths were attributable to excess alcohol consumption. The aim of the present study was to examine the relationship between serum magnesium concentrations and mortality in patients with alcohol withdrawal syndrome (AWS). Materials and methods: A retrospective review of 700 patients with documented evidence of previous AWS indicating a requirement for benzodiazepine prophylaxis or evidence of alcohol withdrawal syndrome between November 2014 and March 2015. Results: Of 380 patients included in the sample analysis, 64 (17{\%}) were dead at 1 year following the time of treatment for AWS. The majority of patients had been prescribed thiamine (77{\%}) and a proton pump inhibitor (66{\%}). In contrast, the majority of patients had low circulating magnesium concentrations (<0.75 mmol/L) (64{\%}) and had not been prescribed magnesium (90{\%}). The median age of death at one year was 55 years (P = 0.002). On univariate analysis, age (P < 0.05), GMAWS (P < 0.05), BDZ (P < 0.05), bilirubin (P < 0.001), alkaline phosphatase (P < 0.001), albumin (P < 0.001), CRP (P < 0.05), AST:ALT ratio >2 (P < 0.001), sodium (P < 0.05), magnesium (P < 0.001), platelets (P < 0.05) and the use of proton pump inhibitor medication (P < 0.001) were associated with death at 1 year. On multivariate binary logistic regression analysis, age > 50 years (OR 3.37, 95{\%} CI 1.52-7.48, P < 0.01), AST:ALT ratio >2 (OR 3.10, 95{\%} CI 1.38-6.94, P < 0.01) and magnesium < 0.75 mmol/L (OR 4.11, 95{\%} CI 1.3-12.8, P < 0.05) remained independently associated with death at 1 year. Conclusion: Overall, 1-year mortality was significantly higher among those patients who were magnesium deficient (<0.75 mmol/L) when compared to those who were replete (≥0.75 mmol/L; P < 0.001).",
keywords = "excess alcohol consumption, alcohol withdrawal syndrome, alcohol related deaths",
author = "Donogh Maguire and Ross, {David P.} and Dinesh Talwar and Ewan Forrest and Abbasi, {Hina Naz} and John-Paul Leach and Marylynne Woods and Zhu, {Luke Y.} and Scott Dickson and Tong Kwok and Isla Waterson and George Benson and Benjamin Scally and David Young and McMillan, {Donald C.}",
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Maguire, D, Ross, DP, Talwar, D, Forrest, E, Abbasi, HN, Leach, J-P, Woods, M, Zhu, LY, Dickson, S, Kwok, T, Waterson, I, Benson, G, Scally, B, Young, D & McMillan, DC 2019, 'Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome', European Journal of Clinical Investigation, vol. 49, no. 9, e13152. https://doi.org/10.1111/eci.13152

Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome. / Maguire, Donogh; Ross, David P.; Talwar, Dinesh; Forrest, Ewan; Abbasi, Hina Naz; Leach, John-Paul; Woods, Marylynne; Zhu, Luke Y.; Dickson, Scott; Kwok, Tong; Waterson, Isla; Benson, George; Scally, Benjamin; Young, David; McMillan, Donald C.

In: European Journal of Clinical Investigation, Vol. 49, No. 9, e13152, 01.09.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome

AU - Maguire, Donogh

AU - Ross, David P.

AU - Talwar, Dinesh

AU - Forrest, Ewan

AU - Abbasi, Hina Naz

AU - Leach, John-Paul

AU - Woods, Marylynne

AU - Zhu, Luke Y.

AU - Dickson, Scott

AU - Kwok, Tong

AU - Waterson, Isla

AU - Benson, George

AU - Scally, Benjamin

AU - Young, David

AU - McMillan, Donald C.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background: In 2014, the WHO reported that 6% of all deaths were attributable to excess alcohol consumption. The aim of the present study was to examine the relationship between serum magnesium concentrations and mortality in patients with alcohol withdrawal syndrome (AWS). Materials and methods: A retrospective review of 700 patients with documented evidence of previous AWS indicating a requirement for benzodiazepine prophylaxis or evidence of alcohol withdrawal syndrome between November 2014 and March 2015. Results: Of 380 patients included in the sample analysis, 64 (17%) were dead at 1 year following the time of treatment for AWS. The majority of patients had been prescribed thiamine (77%) and a proton pump inhibitor (66%). In contrast, the majority of patients had low circulating magnesium concentrations (<0.75 mmol/L) (64%) and had not been prescribed magnesium (90%). The median age of death at one year was 55 years (P = 0.002). On univariate analysis, age (P < 0.05), GMAWS (P < 0.05), BDZ (P < 0.05), bilirubin (P < 0.001), alkaline phosphatase (P < 0.001), albumin (P < 0.001), CRP (P < 0.05), AST:ALT ratio >2 (P < 0.001), sodium (P < 0.05), magnesium (P < 0.001), platelets (P < 0.05) and the use of proton pump inhibitor medication (P < 0.001) were associated with death at 1 year. On multivariate binary logistic regression analysis, age > 50 years (OR 3.37, 95% CI 1.52-7.48, P < 0.01), AST:ALT ratio >2 (OR 3.10, 95% CI 1.38-6.94, P < 0.01) and magnesium < 0.75 mmol/L (OR 4.11, 95% CI 1.3-12.8, P < 0.05) remained independently associated with death at 1 year. Conclusion: Overall, 1-year mortality was significantly higher among those patients who were magnesium deficient (<0.75 mmol/L) when compared to those who were replete (≥0.75 mmol/L; P < 0.001).

AB - Background: In 2014, the WHO reported that 6% of all deaths were attributable to excess alcohol consumption. The aim of the present study was to examine the relationship between serum magnesium concentrations and mortality in patients with alcohol withdrawal syndrome (AWS). Materials and methods: A retrospective review of 700 patients with documented evidence of previous AWS indicating a requirement for benzodiazepine prophylaxis or evidence of alcohol withdrawal syndrome between November 2014 and March 2015. Results: Of 380 patients included in the sample analysis, 64 (17%) were dead at 1 year following the time of treatment for AWS. The majority of patients had been prescribed thiamine (77%) and a proton pump inhibitor (66%). In contrast, the majority of patients had low circulating magnesium concentrations (<0.75 mmol/L) (64%) and had not been prescribed magnesium (90%). The median age of death at one year was 55 years (P = 0.002). On univariate analysis, age (P < 0.05), GMAWS (P < 0.05), BDZ (P < 0.05), bilirubin (P < 0.001), alkaline phosphatase (P < 0.001), albumin (P < 0.001), CRP (P < 0.05), AST:ALT ratio >2 (P < 0.001), sodium (P < 0.05), magnesium (P < 0.001), platelets (P < 0.05) and the use of proton pump inhibitor medication (P < 0.001) were associated with death at 1 year. On multivariate binary logistic regression analysis, age > 50 years (OR 3.37, 95% CI 1.52-7.48, P < 0.01), AST:ALT ratio >2 (OR 3.10, 95% CI 1.38-6.94, P < 0.01) and magnesium < 0.75 mmol/L (OR 4.11, 95% CI 1.3-12.8, P < 0.05) remained independently associated with death at 1 year. Conclusion: Overall, 1-year mortality was significantly higher among those patients who were magnesium deficient (<0.75 mmol/L) when compared to those who were replete (≥0.75 mmol/L; P < 0.001).

KW - excess alcohol consumption

KW - alcohol withdrawal syndrome

KW - alcohol related deaths

U2 - 10.1111/eci.13152

DO - 10.1111/eci.13152

M3 - Article

VL - 49

JO - European Journal of Clinical Investigation

JF - European Journal of Clinical Investigation

SN - 0014-2972

IS - 9

M1 - e13152

ER -

Maguire D, Ross DP, Talwar D, Forrest E, Abbasi HN, Leach J-P et al. Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome. European Journal of Clinical Investigation. 2019 Sep 1;49(9). e13152. https://doi.org/10.1111/eci.13152