Next Article in Journal
Testosterone Replacement Therapy in Chronic Kidney Disease Patients
Next Article in Special Issue
The Response of the Human Umbilical Vein Endothelial Cell Transcriptome to Variation in Magnesium Concentration
Previous Article in Journal / Special Issue
Comment on Guerrero-Romero et al. Magnesium-to-Calcium Ratio and Mortality from COVID-19. Nutrients 2022, 14, 1686
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Reply

Reply to Scarpati, G.; Piazza, O. Comment on “Guerrero-Romero et al. Magnesium-to-Calcium Ratio and Mortality from COVID-19. Nutrients 2022, 14, 1686”

by
Fernando Guerrero-Romero
1,*,
Moises Mercado
2,
Martha Rodríguez-Morán
1,
Claudia Ramírez-Renteria
2,
Gerardo Martínez-Aguilar
1,
Daniel Marrero-Rodríguez
2,
Aldo Ferreira-Hermosillo
2,
Luis E. Simental-Mendía
1,
Ilan Remba-Shapiro
2,
Claudia I. Gamboa-Gómez
1,
Alejandra Albarrán-Sánchez
3 and
Miriam L. Sanchez-García
2
1
Biomedical Research Unit, Instituto Mexicano del Seguro Social, Durango 34067, Mexico
2
Research Unit in Endocrine Diseases, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico
3
Department of Internal Medicine, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico
*
Author to whom correspondence should be addressed.
Nutrients 2022, 14(16), 3443; https://doi.org/10.3390/nu14163443
Submission received: 14 July 2022 / Accepted: 15 August 2022 / Published: 22 August 2022
(This article belongs to the Special Issue Magnesium: From In Vitro to Clinical Research)
We thank Dr. Scarpati and Dr. Piazza for their interest and comments [1] regarding our article on sMg-to-sCa ratio as a biomarker for identifying individuals at high risk of mortality from COVID-19 [2]. Dr. Scarpati and Dr. Piazza propose that iMg “…might be a better marker to identify critically ill patients with an impaired magnesium status and … (and it) may be helpful when replacing this micronutrient”. We completely agree with this statement. Magnesium is predominantly an intracellular cation and its extracellular fraction accounts only for 1% of total body concentration [3], whereas iMg constitutes 50% of total magnesemia and is electrophysiologically active [4]. Thus, the current evidence suggests that iMg is a better indicator of magnesium status. However, the measurement of both sMg and iMg is influenced by pH, changes in serum albumin (sMg), and a lack of standardization of diagnostic reference levels and selective electrodes (iMg) [3,5,6]. Thus, our main point is not whether iMg is a better indicator of body magnesium status than sMg, but to emphasize the importance of the early determination of magnesium-to-calcium balance in patients with COVID-19. The preliminary results of Dr. Scarpati and Dr. Piazza are in agreement with our report, showing that a low sMg-to-sCa ratio is associated with higher mortality in COVID-19 patients. In addition, the results of Dr. Scarpati and Dr. Piazza show that a iMg-to-iCa ratio lower than 0.55 mmol/L is associated with higher mortality in patients with severe COVID-19. Interestingly, the sensitivity of the iMg-to-iCa ratio was 0.90, whereas the sensitivity that we reported using the sMg-to-sCa ratio was 0.83. In this regard, it is necessary to emphasize that the sMg-to-sCa ratio is a measure of the imbalance between magnesium and calcium rather than a marker for magnesium or calcium deficiency. The small difference (0.07) between the sensitivities determined using the ionized and serum fractions of magnesium and calcium supports the abovementioned statement. It is important to highlight that the measurement of iMg and iCa requires specialized equipment not available in all hospitals, whereas the measurement of sMg and sCa is accessible in most laboratories. Thus, iMg is rarely measured in a clinical setting, whereas sMg is the most commonly available and employed test [3]. Finally, Dr. Scarpati and Dr. Piazza raise the following question: “does supplementation of magnesium offer a therapeutic opportunity for severe COVID-19 patients?”. We are convinced that the restoration of magnesium-to-calcium ratio imbalance might offer therapeutic advantages to critically ill patients with COVID-19. Undoubtedly, further research based on randomized clinical trials is needed to verify our hypothesis.

Author Contributions

Conceptualization—all authors; Writing—original draft preparation, F.G.-R. and M.M.; writing—review and editing F.G.-R. and M.M. All authors have read and agreed to the published version of the manuscript.

Funding

Consejo Estatal de Ciencia y Tecnología del Estado de Durango (Numbre 488).

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Scarpati, G.; Piazza, O. Comment on Guerrero-Romero et al. Magnesium-to-Calcium Ratio and Mortality from COVID-19. Nutrients 2022, 14, 1686. Nutrients 2022, 14, 3442. [Google Scholar] [CrossRef]
  2. Guerrero-Romero, F.; Mercado, M.; Rodríguez-Morán, M.; Ramírez-Renteria, C.; Martínez-Aguilar, G.; Marrero-Rodríguez, D.; Ferreira-Hermosillo, A.; Simental-Mendía, L.E.; Remba-Shapiro, I.; Gamboa-Gómez, C.I.; et al. Magnesium-to-Calcium Ratio and Mortality from COVID-19. Nutrients 2022, 14, 1686. [Google Scholar] [CrossRef] [PubMed]
  3. Reddy, S.T.; Soman, S.S.; Yee, J. Magnesium Balance and Measurement. Adv. Chronic Kidney Dis. 2018, 25, 224–229. [Google Scholar] [CrossRef] [PubMed]
  4. Hardwick, L.L.; Jones, M.R.; Buddington, R.K.; Clemens, R.A.; Lee, D.B. Comparison of calcium and magnesium absorption: In vivo and in vitro studies. Am. J. Physiol. 1990, 259 Pt 1, G720–G726. [Google Scholar] [CrossRef] [PubMed]
  5. Saris, N.E.; Mervaala, E.; Karppanen, H.; Khawaja, J.A.; Lewenstam, A. Magnesium. An update on physiological, clinical and analytical aspects. Clin. Chim. Acta 2000, 294, 1–26. [Google Scholar] [CrossRef]
  6. Scarpati, G.; Baldassarre, D.; Oliva, F.; Pascale, G.; Piazza, O. Ionized or Total Magnesium levels, what should we measure in critical ill patients? Transl. Med. UniSa 2020, 23, 68–76. [Google Scholar] [CrossRef] [PubMed]
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Guerrero-Romero, F.; Mercado, M.; Rodríguez-Morán, M.; Ramírez-Renteria, C.; Martínez-Aguilar, G.; Marrero-Rodríguez, D.; Ferreira-Hermosillo, A.; Simental-Mendía, L.E.; Remba-Shapiro, I.; Gamboa-Gómez, C.I.; et al. Reply to Scarpati, G.; Piazza, O. Comment on “Guerrero-Romero et al. Magnesium-to-Calcium Ratio and Mortality from COVID-19. Nutrients 2022, 14, 1686”. Nutrients 2022, 14, 3443. https://doi.org/10.3390/nu14163443

AMA Style

Guerrero-Romero F, Mercado M, Rodríguez-Morán M, Ramírez-Renteria C, Martínez-Aguilar G, Marrero-Rodríguez D, Ferreira-Hermosillo A, Simental-Mendía LE, Remba-Shapiro I, Gamboa-Gómez CI, et al. Reply to Scarpati, G.; Piazza, O. Comment on “Guerrero-Romero et al. Magnesium-to-Calcium Ratio and Mortality from COVID-19. Nutrients 2022, 14, 1686”. Nutrients. 2022; 14(16):3443. https://doi.org/10.3390/nu14163443

Chicago/Turabian Style

Guerrero-Romero, Fernando, Moises Mercado, Martha Rodríguez-Morán, Claudia Ramírez-Renteria, Gerardo Martínez-Aguilar, Daniel Marrero-Rodríguez, Aldo Ferreira-Hermosillo, Luis E. Simental-Mendía, Ilan Remba-Shapiro, Claudia I. Gamboa-Gómez, and et al. 2022. "Reply to Scarpati, G.; Piazza, O. Comment on “Guerrero-Romero et al. Magnesium-to-Calcium Ratio and Mortality from COVID-19. Nutrients 2022, 14, 1686”" Nutrients 14, no. 16: 3443. https://doi.org/10.3390/nu14163443

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop