Association between early intravenous magnesium sulfate administration and mortality according to systemic immune-inflammation index in critically ill patients with acute heart failure: A retrospective cohort study.
- 1Faculty of Medicine, College of Health Sciences, Nam Can Tho University, 168 Nguyen Van Cu Street, An Binh Ward, Can Tho City, 94000, Viet Nam.
- 2Critical Care Department, Nam Can Tho University Medical Center, 168 National Highway 1A, Cai Rang Ward, Can Tho City, 94000, Viet Nam.
Abstract
Background
Magnesium sulfate is commonly administered in acute heart failure (AHF). We investigated the association between early intravenous magnesium sulfate and mortality across baseline systemic immune-inflammation index (SII) strata in critically ill patients with AHF.Methods
We conducted a retrospective study using the MIMIC-IV database of critically ill patients with AHF. Early intravenous magnesium sulfate was defined as treatment initiated from 6 h before to 24 h after intensive care unit admission. SII was categorized into quartiles. The primary and secondary outcomes were 30-day and 90-day all-cause mortality. Multivariable Cox regression, restricted cubic spline, and sensitivity analyses were performed.Results
Among 4293 patients, 1561 (36.4%) received intravenous magnesium sulfate. Magnesium sulfate administration was associated with lower 30-day (adjusted hazard ratio [aHR] 0.68, 95% CI 0.56-0.82) and 90-day mortality (aHR 0.74, 95% CI 0.63-0.86). For 30-day mortality, multivariable Cox regression demonstrated significant associations in the lowest (aHR 0.64, 95% CI 0.43-0.95) and highest (aHR 0.52, 95% CI 0.36-0.75) SII quartiles, whereas no significant associations were identified in the intermediate quartiles. Comparable patterns were observed for 90-day mortality. Restricted cubic spline analyses showed visual separation between treatment groups at the extremes of the SII distribution, although formal interaction testing was not significant. Sensitivity analyses consistently reproduced the association in the highest SII quartile.Conclusions
Stratified analyses suggested that the association between early magnesium sulfate administration and lower mortality was most evident in the highest SII quartile and less consistent in the lowest quartile. These findings are hypothesis-generating and require prospective validation.Trial registration
Not applicable.
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BibTeX
@article{nguyen2026association,
title = {{Association between early intravenous magnesium sulfate administration and mortality according to systemic immune-inflammation index in critically ill patients with acute heart failure: A retrospective cohort study.}},
author = {Thanh Luan Nguyen and Hoang Ngoc Thao Duong and Thi Bao Yen Nguyen and Thuy Oanh Hoang and Ngoc Nhu Y Nguyen and Ngoc Thu Le and Phan Ngoc An Huynh},
journal = {American heart journal plus : cardiology research and practice},
year = {2026},
month = oct,
doi = {10.1016/j.ahjo.2026.100935},
url = {https://europepmc.org/article/MED/42898230},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association between early intravenous magnesium sulfate administration and mortality according to systemic immune-inflammation index in critically ill patients with acute heart failure: A retrospective cohort study.
AU - Thanh Luan Nguyen
AU - Hoang Ngoc Thao Duong
AU - Thi Bao Yen Nguyen
AU - Thuy Oanh Hoang
AU - Ngoc Nhu Y Nguyen
AU - Ngoc Thu Le
AU - Phan Ngoc An Huynh
PY - 2026
DA - 2026/10/06
JO - American heart journal plus : cardiology research and practice
DO - 10.1016/j.ahjo.2026.100935
UR - https://europepmc.org/article/MED/42898230
AB - Background Magnesium sulfate is commonly administered in acute heart failure (AHF). We investigated the association between early intravenous magnesium sulfate and mortality across baseline systemic immune-inflammation index (SII) strata in critically ill patients with AHF.Methods We conducted a retrospective study using the MIMIC-IV database of critically ill patients with AHF. Early intravenous magnesium sulfate was defined as treatment initiated from 6 h before to 24 h after intensive care unit admission. SII was categorized into quartiles. The primary and secondary outcomes were 30-day and 90-day all-cause mortality. Multivariable Cox regression, restricted cubic spline, and sensitivity analyses were performed.Results Among 4293 patients, 1561 (36.4%) received intravenous magnesium sulfate. Magnesium sulfate administration was associated with lower 30-day (adjusted hazard ratio [aHR] 0.68, 95% CI 0.56-0.82) and 90-day mortality (aHR 0.74, 95% CI 0.63-0.86). For 30-day mortality, multivariable Cox regression demonstrated significant associations in the lowest (aHR 0.64, 95% CI 0.43-0.95) and highest (aHR 0.52, 95% CI 0.36-0.75) SII quartiles, whereas no significant associations were identified in the intermediate quartiles. Comparable patterns were observed for 90-day mortality. Restricted cubic spline analyses showed visual separation between treatment groups at the extremes of the SII distribution, although formal interaction testing was not significant. Sensitivity analyses consistently reproduced the association in the highest SII quartile.Conclusions Stratified analyses suggested that the association between early magnesium sulfate administration and lower mortality was most evident in the highest SII quartile and less consistent in the lowest quartile. These findings are hypothesis-generating and require prospective validation.Trial registration Not applicable.
SN - 2666-6022
ER -