Characterization of Hypomagnesemia in Alcoholic Hepatitis Patients and Its Association with Liver Injury and Severity Markers

Introduction: Hypomagnesemia has been documented in alcohol-associated liver disease (ALD). This study aims to characterize hypomagnesemia in alcoholic hepatitis (AH) patients and identify its response with liver injury and severity markers. Materials and Methods: A total of 49 male and female AH patients with an age range of 27-66 years were enrolled in this study. Patients were grouped by MELD: MiAH (mild AH < 12 [n = 5]), MoAH (12 <= moderate AH <= 19 [n = 13]), and SAH (severe AH >= 20 [n = 31]). Patients were also evaluated by MELD grouping as non-severe (MELD <= 19 [n = 18]) and severe (MELD >= 20 [n = 31]). Data were collected on demographics (Age; BMI), drinking history (AUDIT; LTDH), liver injury (ALT; AST), and liver severity (Maddrey's DF; MELD; AST:ALT). Serum magnesium (SMg) levels were tested as SOC lab (normal >= 0.85 <= 1.10 mmol/L). Results: SMg was deficient in each group; the lowest in the MoAH patients. The true positivity of SMg values were at a good performance level when compared between severe and non-severe AH patients (AUROC: 0.695, p = 0.034). We found that the SMg level < 0.78 mmol/L could predict severe AH (sensitivity = 0.100 and 1-specificity = 0.000) at this true positivity, and subsequently analyzed patients with SMg < 0.78 mmol/L (Gr.4) and >= 0.78 mmol/L (Gr.5). Between Gr.4 and Gr.5, there were clinically as well as statistically significant differences in disease severity as defined by MELD, Maddrey's DF, and ABIC scores. Conclusions: This study demonstrates the utility of SMg levels to identify AH patients who may have progressed to severe status. The extent of magnesium response in AH patients also corresponded significantly with the prognosis of liver disease. Physicians suspecting AH in patients with recent heavy drinking may use SMg as an indicator to guide further testing, referrals, or treatment.

Automated summary

This study aims to characterize hypomagnesemia in patients with alcoholic hepatitis (AH) and identify its relationship with liver injury and severity markers. The results show that SMg levels were deficient in all groups, with the lowest levels in the MoAH patients. SMg levels <0.78 mmol/L could predict severe AH, and there were significant differences in disease severity between patients with SMg <0.78 mmol/L and >=0.78 mmol/L. This study demonstrates the utility of SMg levels in identifying severe AH and predicting prognosis.