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Early Magnesium Sulfate Administration and Mortality in Critically Ill Patients with Pneumonia: A Retrospective
Thanh Luan Nguyen1,2, Hoang Ngoc Thao Duong1, Thi Bao Yen Nguyen1
1College of Health Sciences, Nam Can Tho University, Can Tho City, Vietnam.
Abstract:
BackgroundDisturbances in magnesium homeostasis and magnesium supplementation are common in critical illness; however, the association between early intravenous magnesium sulfate administration and clinical outcomes in critically ill patients with pneumonia remains unclear.MethodsThis retrospective observational cohort study used data from the Medical Information Mart for Intensive Care IV (version 3.1) database and included critically ill patients admitted to the intensive care unit (ICU) with pneumonia. Patients were classified according to early exposure to intravenous magnesium sulfate, defined as administration from 6 h before to 24 h after ICU admission, or no exposure during this period. The primary outcome was 30-day all-cause mortality, with secondary outcomes including 60-day and 90-day mortality. Associations were evaluated using multivariable Cox proportional hazards models, with prespecified subgroup, interaction, and sensitivity analyses, including propensity score matching.ResultsAmong 9203 eligible patients, 2975 (32.3%) received early intravenous magnesium sulfate. Magnesium sulfate administration was associated with lower 30-day mortality after multivariable adjustment (adjusted hazard ratio [aHR] 0.84; 95% confidence interval [CI] 0.76-0.94; p = .002). Similar associations were observed for 60-day mortality (aHR 0.86; 95% CI 0.78-0.95; p = .002) and 90-day mortality (aHR 0.87; 95% CI 0.80-0.96; p = .004). Subgroup analysis identified a significant interaction for sepsis status (p for interaction = .007). In a propensity score-matched cohort, magnesium sulfate administration remained associated with lower 30-day mortality (aHR 0.85; 95% CI 0.74-0.96; p = .012).ConclusionsIn critically ill patients with pneumonia, early intravenous magnesium sulfate administration was associated with lower mortality. These findings are hypothesis-generating and suggest the need for prospective studies to clarify causality and define optimal dosing and duration of magnesium supplementation in this population.
Insights
Early intravenous magnesium sulfate in critically ill pneumonia patients was linked to reduced 30-day mortality. This study suggests magnesium may improve survival in these patients, warranting further investigation.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Epidemiology
Background:
- Magnesium homeostasis disturbances are frequent in critical illness.
- The impact of early intravenous magnesium sulfate on pneumonia patient outcomes is not well-established.
Purpose of the Study:
- To investigate the association between early intravenous magnesium sulfate administration and mortality in critically ill pneumonia patients.
Main Methods:
- Retrospective cohort study using the MIMIC-IV database.
- Included critically ill pneumonia patients, comparing early magnesium sulfate exposure (6h pre- to 24h post-ICU admission) with no exposure.
- Analyzed 30-day, 60-day, and 90-day all-cause mortality using multivariable Cox models and propensity score matching.
Main Results:
- Early magnesium sulfate administration was associated with significantly lower 30-day mortality (aHR 0.84; 95% CI 0.76-0.94).
- Similar reductions were observed for 60-day (aHR 0.86) and 90-day mortality (aHR 0.87).
- Propensity score matching confirmed the association with lower 30-day mortality (aHR 0.85).
Conclusions:
- Early intravenous magnesium sulfate in critically ill pneumonia patients is associated with reduced mortality.
- Findings are hypothesis-generating, indicating a need for prospective trials to confirm causality and optimize magnesium therapy.
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