Xie Linfeng, Chen Jing, Li Yuanzhu, Luo Suxin, Huang Bi
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
Cardiovasc Drugs Ther. 2025 May 5. doi: 10.1007/s10557-025-07708-y.
Magnesium ions are essential inorganic ions in the body, playing a crucial role in normal physiological functions. Previous studies have shown that supplementing magnesium sulfate can provide survival advantages for critically ill patients. Our study aimed to explore whether intravenous magnesium sulfate could provide a survival advantage in patients with cardiogenic shock (CS).
This is a retrospective cohort study based on the Medical Information Mart in Intensive Care (MIMIC) IV database. The study participants were CS patients. The study endpoints were 30-day, 90-day, and 360-day all-cause mortality. The external validation was performed in the eICU 2.0 database.
The pre-matched and propensity score-matched (PSM) cohorts included 2547 and 830 patients, respectively. In the overall patient cohort, multivariable Cox regression showed that magnesium supplementation was associated with a reduced risk of 30-day (HR 0.635; 95% CI 0.539, 0.749; p < 0.001), 90-day (HR 0.687; 95% CI 0.591, 0.749; p < 0.001), and 360-day all-cause mortality (HR 0.681; 95% CI 0.593, 0.782; p < 0.001). This association remained consistent after PSM in 30-day (HR 0.624; 95% CI 0.506, 0.768; p < 0.001), 90-day (HR 0.640; 95% CI 0.530, 0.774; p < 0.001), and 360-day all-cause mortality (HR 0.629; 95% CI 0.529, 0.749; p < 0.001). Subgroup analysis found that the effect of the magnesium supplement was consistent in different subgroup patients, including in patients with hypomagnesemia versus non-hypomagnesemia (all p-interaction > 0.05). In 1867 CS patients from eICU 2.0 for external validation, after PSM, intravenous magnesium sulfate use was associated with lower in-hospital (HR 0.742; 95% CI 0.578, 0.952; p = 0.019) and in-ICU all-cause mortality (HR 0.729; 95% CI 0.555, 0.958; p = 0.023).
Intravenous magnesium sulfate use was associated with reduced risk of all-cause mortality in patients with CS, and this benefit was not affected by patients' serum magnesium levels. Prospective studies are warranted to verify this finding.
镁离子是人体必需的无机离子，在正常生理功能中发挥着关键作用。先前的研究表明，补充硫酸镁可为重症患者提供生存优势。我们的研究旨在探讨静脉注射硫酸镁是否能为心源性休克（CS）患者提供生存优势。
这是一项基于重症监护医学信息集市（MIMIC）IV数据库的回顾性队列研究。研究参与者为CS患者。研究终点为30天、90天和360天的全因死亡率。在eICU 2.0数据库中进行外部验证。
预匹配和倾向评分匹配（PSM）队列分别包括2547例和830例患者。在总体患者队列中，多变量Cox回归显示，补充镁与降低30天（HR 0.635；95%CI 0.539，0.749；p<0.001）、90天（HR 0.687；95%CI 0.591，0.749；p<0.001）和360天全因死亡率的风险相关（HR 0.681；95%CI 0.593，0.782；p<0.001）。PSM后，这种关联在30天（HR 0.624；95%CI 0.506，0.768；p<0.001）、90天（HR 0.640；95%CI 0.530，0.774；p<0.001）和360天全因死亡率中保持一致（HR 0.629；95%CI 0.529，0.749；p<0.001）。亚组分析发现，补充镁的效果在不同亚组患者中一致，包括低镁血症患者与非低镁血症患者（所有p交互作用>0.05）。在来自eICU 2.0的1867例CS患者中进行外部验证，PSM后，静脉注射硫酸镁与较低的住院期间（HR 0.742；95%CI 0.578，0.952；p = 0.019）和ICU全因死亡率相关（HR 0.729；95%CI 0.555，0.958；p = 0.023）。
静脉注射硫酸镁与降低CS患者的全因死亡率风险相关，且这种益处不受患者血清镁水平的影响。有必要进行前瞻性研究以验证这一发现。
