Journal of Southern Medical University ›› 2025, Vol. 45 ›› Issue (12): 2616-2627.doi: 10.12122/j.issn.1673-4254.2025.12.09
Mengyao YUAN1,2(
), Xianghan RUAN1,2, Yang LI1, Ting ZHANG1, Chunxiang HAO1, Hao LI1, Jingsheng LOU1, Jiangbei CAO1, Yanhong LIU1, Weidong MI1(), Xiaoying ZHANG1()
Received:2025-07-15
Online:2025-12-20
Published:2025-12-22
Contact:
Weidong MI, Xiaoying ZHANG
E-mail:yuanmengyaoup@126.com;wwdd1962@163.com;zxystudy@163.com
Mengyao YUAN, Xianghan RUAN, Yang LI, Ting ZHANG, Chunxiang HAO, Hao LI, Jingsheng LOU, Jiangbei CAO, Yanhong LIU, Weidong MI, Xiaoying ZHANG. Preoperative serum magnesium as a biomarker for predicting delirium following non-cardiac surgery in elderly patients: a retrospective cohort study[J]. Journal of Southern Medical University, 2025, 45(12): 2616-2627.
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URL: https://www.j-smu.com/EN/10.12122/j.issn.1673-4254.2025.12.09
Fig.1 Flowchart of enrollment of patients with postoperative delirium in this study.
| Characteristics | Overall | Preoperative serum magnesium levels (mmol/L) | P | ||||
|---|---|---|---|---|---|---|---|
Quintile 1 (0.36-0.82) | Quintile 2 (0.82-0.87) | Quintile 3 (0.87-0.90) | Quintile 4 (0.90-0.94) | Quintile 5 (0.94-1.44) | |||
| Case (n) | 12 876 | 2322 | 2781 | 2278 | 2641 | 2854 | |
| sMg (mmol/L, Mean±SD) | 0.88±0.08 | 0.76±0.05 | 0.84±0.01 | 0.88±0.01 | 0.91±0.01 | 0.98±0.04 | <0.001 |
| Demographics | |||||||
| Age (year, median [IQR]) | 70 (67, 75) | 71 (67, 77) | 70 (67, 75) | 71 (67, 75) | 70 (67, 75) | 70 (67, 75) | <0.001 |
| Male | 6110 (47.5%) | 1125 (48.4%) | 1296 (46.6%) | 1092 (47.9%) | 1268 (48.0%) | 1329 (46.6%) | 0.529 |
| BMI (kg/m2, Mean±SD) | 24.6±3.9 | 24.2±4.1 | 24.8±4.0 | 24.8±3.9 | 24.7±3.8 | 24.5±3.8 | <0.001 |
| Comorbidities | |||||||
| Diabetes mellitus | 3373 (26.2%) | 855 (36.8%) | 786 (28.3%) | 553 (24.3%) | 584 (22.1%) | 595 (20.8%) | <0.001 |
| Cancer | 5158 (40.1%) | 901 (38.8%) | 1006 (36.2%) | 904 (39.7%) | 1101 (41.7%) | 1246 (43.7%) | <0.001 |
| Renal insufficiency | 309 (2.4%) | 69 (3.0%) | 64 (2.3%) | 41 (1.8%) | 50 (1.9%) | 85 (3.0%) | 0.008 |
| Liver cirrhosis | 389 (3.0%) | 80 (3.4%) | 93 (3.3%) | 61 (2.7%) | 73 (2.8%) | 82 (2.9%) | 0.387 |
| Laboratory measurements | |||||||
| CRP [mg/L (median, IQR)] | 0.43 (0.10, 1.59) | 0.77 (0.19, 3.00) | 0.42 (0.10, 1.59) | 0.37 (0.10, 1.24) | 0.37 (0.10, 1.18) | 0.42 (0.11, 1.40) | <0.001 |
| SCr (μmol/L, Mean±SD) | 75.35±42.48 | 73.41±35.74 | 72.05±27.39 | 73.89±32.44 | 74.35±33.44 | 82.33±66.83 | <0.001 |
| TBil (μmol/L, Mean±SD) | 20.77±41.85 | 24.88±48.79 | 20.81±43.62 | 18.81±35.98 | 19.17±36.62 | 20.45±42.65 | <0.001 |
| ALT (U/L, Mean±SD) | 25.99±50.93 | 31.59±93.86 | 25.15±45.43 | 24.49±32.40 | 24.49±27.41 | 24.82±31.02 | <0.001 |
| Albumin (g/L, Mean±SD) | 38.32±4.43 | 36.31±4.85 | 38.02±4.28 | 38.67±4.00 | 38.98±4.09 | 39.37±4.29 | <0.001 |
| sCa (mmol/L, Mean±SD) | 2.24±0.13 | 2.21±0.17 | 2.23±0.13 | 2.24±0.12 | 2.25±0.12 | 2.25±0.12 | <0.001 |
| Surgery-related factors | |||||||
| Emergency surgery | 1298 (5.9%) | 447 (11.2%) | 252 (5.2%) | 164 (4.3%) | 187 (4.1%) | 248 (5.1%) | <0.001 |
| Surgery specialty | <0.001 | ||||||
Otorhinolaryngology-head &neck, plastic,or abdominal wallsurgery | 1104 (8.6%) | 129 (5.6%) | 223 (8.0%) | 196 (8.6%) | 264 (10.0%) | 292 (10.2%) | |
| Obstetrics/gynecology | 80 (0.6%) | 21 (0.9%) | 21 (0.8%) | 11 (0.5%) | 12 (0.5%) | 15 (0.5%) | |
| Urology | 260 (2.0%) | 38 (1.6%) | 57 (2.0%) | 49 (2.2%) | 46 (1.7%) | 70 (2.5%) | |
| Hepatobiliary/pancreatic/ gastrointestinal | 4081 (31.7%) | 798 (34.4%) | 761 (27.4%) | 664 (29.1%) | 864 (32.7%) | 994 (34.8%) | |
| Vascular | 431 (3.3%) | 73 (3.1%) | 97 (3.5%) | 77 (3.4%) | 87 (3.3%) | 97 (3.4%) | |
| Orthopedic | 5940 (46.1%) | 1030 (44.4%) | 1417 (51.0%) | 1093 (48.0%) | 1193 (45.2%) | 1207 (42.3%) | |
| Endoscopic | 739 (5.7%) | 196 (8.4%) | 153 (5.5%) | 139 (6.1%) | 123 (4.7%) | 128 (4.5%) | |
| Thoracic | 241 (1.9%) | 37 (1.6%) | 52 (1.9%) | 49 (2.2%) | 52 (2.0%) | 51 (1.8%) | |
| Surgery duration (h, median [IQR]) | 2.08 (1.42, 3.17) | 2.04 (1.42, 3.08) | 2.05 (1.42, 3.08) | 2.08 (1.42, 3.17) | 2.08 (1.42, 3.25) | 2.17 (1.45, 3.25) | 0.445 |
| Outcome | |||||||
| POD | 685 (5.3%) | 218 (9.4%) | 146 (5.2%) | 111 (4.9%) | 99 (3.7%) | 111 (3.9%) | <0.001 |
Tab.1 Baseline characteristics of the patients stratified by preoperative serum magnesium level quintiles
| Characteristics | Overall | Preoperative serum magnesium levels (mmol/L) | P | ||||
|---|---|---|---|---|---|---|---|
Quintile 1 (0.36-0.82) | Quintile 2 (0.82-0.87) | Quintile 3 (0.87-0.90) | Quintile 4 (0.90-0.94) | Quintile 5 (0.94-1.44) | |||
| Case (n) | 12 876 | 2322 | 2781 | 2278 | 2641 | 2854 | |
| sMg (mmol/L, Mean±SD) | 0.88±0.08 | 0.76±0.05 | 0.84±0.01 | 0.88±0.01 | 0.91±0.01 | 0.98±0.04 | <0.001 |
| Demographics | |||||||
| Age (year, median [IQR]) | 70 (67, 75) | 71 (67, 77) | 70 (67, 75) | 71 (67, 75) | 70 (67, 75) | 70 (67, 75) | <0.001 |
| Male | 6110 (47.5%) | 1125 (48.4%) | 1296 (46.6%) | 1092 (47.9%) | 1268 (48.0%) | 1329 (46.6%) | 0.529 |
| BMI (kg/m2, Mean±SD) | 24.6±3.9 | 24.2±4.1 | 24.8±4.0 | 24.8±3.9 | 24.7±3.8 | 24.5±3.8 | <0.001 |
| Comorbidities | |||||||
| Diabetes mellitus | 3373 (26.2%) | 855 (36.8%) | 786 (28.3%) | 553 (24.3%) | 584 (22.1%) | 595 (20.8%) | <0.001 |
| Cancer | 5158 (40.1%) | 901 (38.8%) | 1006 (36.2%) | 904 (39.7%) | 1101 (41.7%) | 1246 (43.7%) | <0.001 |
| Renal insufficiency | 309 (2.4%) | 69 (3.0%) | 64 (2.3%) | 41 (1.8%) | 50 (1.9%) | 85 (3.0%) | 0.008 |
| Liver cirrhosis | 389 (3.0%) | 80 (3.4%) | 93 (3.3%) | 61 (2.7%) | 73 (2.8%) | 82 (2.9%) | 0.387 |
| Laboratory measurements | |||||||
| CRP [mg/L (median, IQR)] | 0.43 (0.10, 1.59) | 0.77 (0.19, 3.00) | 0.42 (0.10, 1.59) | 0.37 (0.10, 1.24) | 0.37 (0.10, 1.18) | 0.42 (0.11, 1.40) | <0.001 |
| SCr (μmol/L, Mean±SD) | 75.35±42.48 | 73.41±35.74 | 72.05±27.39 | 73.89±32.44 | 74.35±33.44 | 82.33±66.83 | <0.001 |
| TBil (μmol/L, Mean±SD) | 20.77±41.85 | 24.88±48.79 | 20.81±43.62 | 18.81±35.98 | 19.17±36.62 | 20.45±42.65 | <0.001 |
| ALT (U/L, Mean±SD) | 25.99±50.93 | 31.59±93.86 | 25.15±45.43 | 24.49±32.40 | 24.49±27.41 | 24.82±31.02 | <0.001 |
| Albumin (g/L, Mean±SD) | 38.32±4.43 | 36.31±4.85 | 38.02±4.28 | 38.67±4.00 | 38.98±4.09 | 39.37±4.29 | <0.001 |
| sCa (mmol/L, Mean±SD) | 2.24±0.13 | 2.21±0.17 | 2.23±0.13 | 2.24±0.12 | 2.25±0.12 | 2.25±0.12 | <0.001 |
| Surgery-related factors | |||||||
| Emergency surgery | 1298 (5.9%) | 447 (11.2%) | 252 (5.2%) | 164 (4.3%) | 187 (4.1%) | 248 (5.1%) | <0.001 |
| Surgery specialty | <0.001 | ||||||
Otorhinolaryngology-head &neck, plastic,or abdominal wallsurgery | 1104 (8.6%) | 129 (5.6%) | 223 (8.0%) | 196 (8.6%) | 264 (10.0%) | 292 (10.2%) | |
| Obstetrics/gynecology | 80 (0.6%) | 21 (0.9%) | 21 (0.8%) | 11 (0.5%) | 12 (0.5%) | 15 (0.5%) | |
| Urology | 260 (2.0%) | 38 (1.6%) | 57 (2.0%) | 49 (2.2%) | 46 (1.7%) | 70 (2.5%) | |
| Hepatobiliary/pancreatic/ gastrointestinal | 4081 (31.7%) | 798 (34.4%) | 761 (27.4%) | 664 (29.1%) | 864 (32.7%) | 994 (34.8%) | |
| Vascular | 431 (3.3%) | 73 (3.1%) | 97 (3.5%) | 77 (3.4%) | 87 (3.3%) | 97 (3.4%) | |
| Orthopedic | 5940 (46.1%) | 1030 (44.4%) | 1417 (51.0%) | 1093 (48.0%) | 1193 (45.2%) | 1207 (42.3%) | |
| Endoscopic | 739 (5.7%) | 196 (8.4%) | 153 (5.5%) | 139 (6.1%) | 123 (4.7%) | 128 (4.5%) | |
| Thoracic | 241 (1.9%) | 37 (1.6%) | 52 (1.9%) | 49 (2.2%) | 52 (2.0%) | 51 (1.8%) | |
| Surgery duration (h, median [IQR]) | 2.08 (1.42, 3.17) | 2.04 (1.42, 3.08) | 2.05 (1.42, 3.08) | 2.08 (1.42, 3.17) | 2.08 (1.42, 3.25) | 2.17 (1.45, 3.25) | 0.445 |
| Outcome | |||||||
| POD | 685 (5.3%) | 218 (9.4%) | 146 (5.2%) | 111 (4.9%) | 99 (3.7%) | 111 (3.9%) | <0.001 |
Fig.2 Directed acyclic graph showing associations among the covariates, primary exposure, and the outcome. White circles denote ancestors of both the exposure and outcome that have been controlled as confounders, blue circles represent the outcome and its causal direct determinants, green circle symbolizes the exposure variable, and the gray circle denotes variables that are unobserved. The causal relationships are depicted by green lines, and gray lines illustrate the paths of bias that have been accounted for. Conversely, pink lines highlight the biasing paths that remain unadjusted due to latent variables. OR: Odds ratio; CI: Confidence interval; U: Unmeasured confounders.
| Variables | Events [n (%)] | Model 1a | Model 2b | Model 3c | |||
|---|---|---|---|---|---|---|---|
| (P trend=0.004) | (P trend=0.054) | (P trend=0.036) | |||||
| OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | ||
| Continuous | |||||||
| Standardized sMg | 685 (5.3%) | 0.71 (0.66, 0.76) | <0.001 | 0.83 (0.77, 0.89) | <0.001 | 0.84 (0.78, 0.90) | <0.001 |
| Categoricale | |||||||
| Quintile 1 | 218 (9.4%) | 2.66 (2.09, 3.41) | <0.001 | 1.81 (1.41, 2.35) | <0.001 | 1.77 (1.37, 2.29) | <0.001 |
| Quintile 2 | 146 (5.2%) | 1.42 (1.10, 1.85) | 0.008 | 1.26 (0.97, 1.65) | 0.091 | 1.25 (0.96, 1.64) | 0.097 |
| Quintile 3 | 111 (4.9%) | 1.32 (1.00, 1.74) | 0.052 | 1.27 (0.96, 1.68) | 0.096 | 1.27 (0.96, 1.69) | 0.096 |
| Quintile 4 | 99 (3.7%) | 1 (reference) | 1 (reference) | 1 (reference) | |||
| Quintile 5 | 111 (3.9%) | 1.04 (0.79, 1.37) | 0.786 | 1.06 (0.80, 1.40) | 0.708 | 1.01 (0.76, 1.34) | 0.941 |
Tab.2 Association between preoperative sMg levels and POD risk in univariate and multivariable logistic regression models
| Variables | Events [n (%)] | Model 1a | Model 2b | Model 3c | |||
|---|---|---|---|---|---|---|---|
| (P trend=0.004) | (P trend=0.054) | (P trend=0.036) | |||||
| OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | ||
| Continuous | |||||||
| Standardized sMg | 685 (5.3%) | 0.71 (0.66, 0.76) | <0.001 | 0.83 (0.77, 0.89) | <0.001 | 0.84 (0.78, 0.90) | <0.001 |
| Categoricale | |||||||
| Quintile 1 | 218 (9.4%) | 2.66 (2.09, 3.41) | <0.001 | 1.81 (1.41, 2.35) | <0.001 | 1.77 (1.37, 2.29) | <0.001 |
| Quintile 2 | 146 (5.2%) | 1.42 (1.10, 1.85) | 0.008 | 1.26 (0.97, 1.65) | 0.091 | 1.25 (0.96, 1.64) | 0.097 |
| Quintile 3 | 111 (4.9%) | 1.32 (1.00, 1.74) | 0.052 | 1.27 (0.96, 1.68) | 0.096 | 1.27 (0.96, 1.69) | 0.096 |
| Quintile 4 | 99 (3.7%) | 1 (reference) | 1 (reference) | 1 (reference) | |||
| Quintile 5 | 111 (3.9%) | 1.04 (0.79, 1.37) | 0.786 | 1.06 (0.80, 1.40) | 0.708 | 1.01 (0.76, 1.34) | 0.941 |
Fig.3 Association between preoperative sMg levels and POD risk on continuous scales. A: Model 1 (unadjusted model). B: Model 2 (multivariable model adjusted for age, sex, BMI, albumin, TBil, ALT, diabetes mellitus, cancer and renal insufficiency). C: Model 3 (multivariable model additionally adjusted for CRP levels as a potential mediator). ORs are indicated by blue solid lines and 95% CIs by light blue dotted lines. Reference lines for no association are indicated by the blackdotted lines at an OR of 1.0. Density plots are presented by gray shadow area to show the fraction of the population with different levels of sMg. sMg level corresponding to the OR equal to 1 (reference value) is shown by dark spot.
Fig.4 Association between preoperative sMg levels and POD risk based on quintile analyses. Forest plots show associations in the overall population (A, B) and subgroups (C-F). Subgroup analyses were adjusted as in model 2.
| Subgroup | OR (95% CI) of serum magnesium quintiles | P for trend | P for interaction | ||||
|---|---|---|---|---|---|---|---|
| Quintile 1 | Quintile 2 | Quintile 3 | Quintile 4 | Quintile 5 | |||
| Age (year) | 0.013 | ||||||
| <75 (n=9169) | 1.88 (1.34, 2.67) | 1.30 (0.91, 1.86) | 1.27 (0.87, 1.85) | 1 (reference) | 1.01 (0.69, 1.46) | 0.018 | |
| ≥75 (n=3707) | 1.73 (1.19, 2.56) | 1.54 (1.05, 2.28) | 1.32 (0.87, 2.00) | 1 (reference) | 1.06 (0.70, 1.61) | 0.138 | |
| Gender | 0.358 | ||||||
| Male (n=6110) | 1.84 (1.30, 2.62) | 1.23 (0.85, 1.79) | 1.40 (0.97, 2.05) | 1 (reference) | 1.16 (0.80, 1.69) | 0.150 | |
| Female (n=6766) | 1.81 (1.26, 2.65) | 1.64 (1.14, 2.39) | 1.22 (0.81, 1.84) | 1 (reference) | 0.92 (0.61, 1.39) | 0.011 | |
| Diabetes mellitus | 0.595 | ||||||
| No (n=9503) | 1.67 (1.23, 2.27) | 1.44 (1.06, 1.96) | 1.20 (0.87, 1.67) | 1 (reference) | 1.01 (0.73, 1.39) | 0.023 | |
| Yes (n=3373) | 2.15 (1.33, 3.46) | 1.35 (0.82, 2.28) | 1.62 (0.96, 2.79) | 1 (reference) | 1.15 (0.66, 2.03) | 0.166 | |
| Cancer | 0.043 | ||||||
| No (n=7718) | 2.15 (1.57, 2.98) | 1.18 (0.84, 1.66) | 1.36 (0.96, 1.94) | 1 (reference) | 0.84 (0.58, 1.22) | 0.025 | |
| Yes (n=5158) | 2.67 (1.82, 3.99) | 1.88 (1.26, 2.85) | 1.23 (0.78, 1.93) | 1 (reference) | 1.33 (0.88, 2.02) | 0.076 | |
Tab.3 Associations between preoperative sMg levels and POD risk based on quintile analysis
| Subgroup | OR (95% CI) of serum magnesium quintiles | P for trend | P for interaction | ||||
|---|---|---|---|---|---|---|---|
| Quintile 1 | Quintile 2 | Quintile 3 | Quintile 4 | Quintile 5 | |||
| Age (year) | 0.013 | ||||||
| <75 (n=9169) | 1.88 (1.34, 2.67) | 1.30 (0.91, 1.86) | 1.27 (0.87, 1.85) | 1 (reference) | 1.01 (0.69, 1.46) | 0.018 | |
| ≥75 (n=3707) | 1.73 (1.19, 2.56) | 1.54 (1.05, 2.28) | 1.32 (0.87, 2.00) | 1 (reference) | 1.06 (0.70, 1.61) | 0.138 | |
| Gender | 0.358 | ||||||
| Male (n=6110) | 1.84 (1.30, 2.62) | 1.23 (0.85, 1.79) | 1.40 (0.97, 2.05) | 1 (reference) | 1.16 (0.80, 1.69) | 0.150 | |
| Female (n=6766) | 1.81 (1.26, 2.65) | 1.64 (1.14, 2.39) | 1.22 (0.81, 1.84) | 1 (reference) | 0.92 (0.61, 1.39) | 0.011 | |
| Diabetes mellitus | 0.595 | ||||||
| No (n=9503) | 1.67 (1.23, 2.27) | 1.44 (1.06, 1.96) | 1.20 (0.87, 1.67) | 1 (reference) | 1.01 (0.73, 1.39) | 0.023 | |
| Yes (n=3373) | 2.15 (1.33, 3.46) | 1.35 (0.82, 2.28) | 1.62 (0.96, 2.79) | 1 (reference) | 1.15 (0.66, 2.03) | 0.166 | |
| Cancer | 0.043 | ||||||
| No (n=7718) | 2.15 (1.57, 2.98) | 1.18 (0.84, 1.66) | 1.36 (0.96, 1.94) | 1 (reference) | 0.84 (0.58, 1.22) | 0.025 | |
| Yes (n=5158) | 2.67 (1.82, 3.99) | 1.88 (1.26, 2.85) | 1.23 (0.78, 1.93) | 1 (reference) | 1.33 (0.88, 2.02) | 0.076 | |
Fig.5 Distribution of CRP levels before and after logarithmic transformation. A: Histogram of the distribution of preoperative CRP levels. B: Histogram of the distribution of preoperative log10 CRP levels.
Fig.6 Mediation analyses of the associations between preoperative serum magnesium levels and POD risk through log10CRP levels. Mediation analyses were conducted in the overall population (A) and in key subgroups, including cancer (B), non-cancer (C), age <75 years (D), and age ≥75 years (E) Mediation groups. Subgroup analyses were adjusted as in model 2. a=the effects of sMg on log10 CRP; b=the effects of log10 CRP on POD Risk. a*b: the indirect effect; c: the total effect; c': the direct effect. **P<0.01,***P<0.001.
Pathways sMg→log10 CRP→POD | c | P | c' | P | a*b | P | a | P | b | P | |ab/c| |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall | -0.35 | <0.001 | -0.29 | <0.001 | -0.06 | 0.007 | -0.17 | <0.001 | 0.35 | <0.001 | 17.14% |
| Age (year) | |||||||||||
| <75 | -0.41 | <0.001 | -0.35 | 0.006 | -0.06 | <0.001 | -0.17 | <0.001 | 0.35 | <0.001 | 14.63% |
| ≥75 | -0.24 | 0.005 | -0.20 | 0.008 | -0.04 | 0.006 | -0.25 | 0.005 | 0.29 | <0.001 | 16.67% |
| Cancer | |||||||||||
| Absent | -0.29 | 0.015 | -0.22 | 0.003 | -0.07 | 0.008 | -0.19 | <0.001 | 0.36 | <0.001 | 24.14% |
| Present | -0.42 | <0.001 | -0.37 | <0.001 | -0.05 | 0.010 | -0.17 | <0.001 | 0.35 | <0.001 | 11.90% |
Tab.4 Mediation analysis in the overall population and subgroups
Pathways sMg→log10 CRP→POD | c | P | c' | P | a*b | P | a | P | b | P | |ab/c| |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall | -0.35 | <0.001 | -0.29 | <0.001 | -0.06 | 0.007 | -0.17 | <0.001 | 0.35 | <0.001 | 17.14% |
| Age (year) | |||||||||||
| <75 | -0.41 | <0.001 | -0.35 | 0.006 | -0.06 | <0.001 | -0.17 | <0.001 | 0.35 | <0.001 | 14.63% |
| ≥75 | -0.24 | 0.005 | -0.20 | 0.008 | -0.04 | 0.006 | -0.25 | 0.005 | 0.29 | <0.001 | 16.67% |
| Cancer | |||||||||||
| Absent | -0.29 | 0.015 | -0.22 | 0.003 | -0.07 | 0.008 | -0.19 | <0.001 | 0.36 | <0.001 | 24.14% |
| Present | -0.42 | <0.001 | -0.37 | <0.001 | -0.05 | 0.010 | -0.17 | <0.001 | 0.35 | <0.001 | 11.90% |
| Analysis | OR (95% CI) | P for trend | ||||
|---|---|---|---|---|---|---|
Quintile 1 (0.36-0.82) | Quintile 2 (0.82-0.87) | Quintile 3 (0.87-0.90) | Quintile 4 (0.90-0.94) | Quintile 5 (0.94-1.44) | ||
| Primary analysis | 1.81 (1.41, 2.35) | 1.26 (0.97, 1.65) | 1.27 (0.96, 1.68) | 1 (reference) | 1.06 (0.80, 1.40) | 0.054 |
| Sensitivity analysis | ||||||
Additional adjustment for major intraoperative factorsa (n=12 876) | 1.89 (1.47, 2.45) | 1.26 (0.97, 1.65) | 1.30 (0.98, 1.72) | 1 (reference) | 1.05 (0.80, 1.40) | 0.175 |
Excluding patients with confounders missing (n=12 570) | 1.79 (1.37, 2.29) | 1.25 (0.96, 1.64) | 1.29 (0.96,1.69) | 1 (reference) | 1.03 (0.75,1.32) | 0.188 |
| Excluding patients with dystrophy (n=12 246) | 1.81 (1.39, 2.37) | 1.28 (0.97, 1.69) | 1.29 (0.97, 1.73) | 1 (reference) | 1.04 (0.78, 1.40) | 0.240 |
Excluding patients with inflammation, hepatic or renal insufficiency (n=12 156) | 1.92 (1.48, 2.52) | 1.30 (0.99, 1.72) | 1.26 (0.93, 1.69) | 1 (reference) | 1.04 (0.77, 1.40) | 0.124 |
Tab.5 Sensitivity analysis for associations between preoperative serum magnesium levels and POD risk
| Analysis | OR (95% CI) | P for trend | ||||
|---|---|---|---|---|---|---|
Quintile 1 (0.36-0.82) | Quintile 2 (0.82-0.87) | Quintile 3 (0.87-0.90) | Quintile 4 (0.90-0.94) | Quintile 5 (0.94-1.44) | ||
| Primary analysis | 1.81 (1.41, 2.35) | 1.26 (0.97, 1.65) | 1.27 (0.96, 1.68) | 1 (reference) | 1.06 (0.80, 1.40) | 0.054 |
| Sensitivity analysis | ||||||
Additional adjustment for major intraoperative factorsa (n=12 876) | 1.89 (1.47, 2.45) | 1.26 (0.97, 1.65) | 1.30 (0.98, 1.72) | 1 (reference) | 1.05 (0.80, 1.40) | 0.175 |
Excluding patients with confounders missing (n=12 570) | 1.79 (1.37, 2.29) | 1.25 (0.96, 1.64) | 1.29 (0.96,1.69) | 1 (reference) | 1.03 (0.75,1.32) | 0.188 |
| Excluding patients with dystrophy (n=12 246) | 1.81 (1.39, 2.37) | 1.28 (0.97, 1.69) | 1.29 (0.97, 1.73) | 1 (reference) | 1.04 (0.78, 1.40) | 0.240 |
Excluding patients with inflammation, hepatic or renal insufficiency (n=12 156) | 1.92 (1.48, 2.52) | 1.30 (0.99, 1.72) | 1.26 (0.93, 1.69) | 1 (reference) | 1.04 (0.77, 1.40) | 0.124 |
Fig. 7 Curves of the sensitivity analyses for unobserved confounders with E-value highlighted. A: E-value for quintile 1 point estimate: 3.02 and for confidence interval: 2.17. B: E-value for quintile 2 point estimate: 1.83 and for confidence interval: 1. C: E-value for quintile 5 point estimate:1.31 and for confidence interval: 1.
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