Dynamic Magnesium Replacement Strategies and 28-Day Mortality in Non-Cardiac Critically Ill Patients With Hypomagnesemia: A Target Trial Emulation

Dynamic Magnesium Replacement Strategies and 28-Day All-Cause Mortality in Non-Cardiac Critically Ill Patients With Hypomagnesemia: A Target Trial Emulation Using the MIMIC-IV Database (2008-2019)

Status

Completed

Phases

Unknown

Study type

Observational

Source

ClinicalTrials.gov

Registry ID

NCT07380542

Enrollment

12887

Registered

2026-02-02

Start date

2025-09-01

Completion date

2025-12-31

Last updated

2026-02-02

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Hypomagnesemia

Keywords

Magnesium Replacement Therapy, 28-Day Mortality, Intensive Care Unit Patients, Target Trial Emulation, Retrospective Cohort Study

Brief summary

This study looks at how different ways of giving magnesium (a nutrient) affect the risk of death within 28 days for adults with low magnesium levels who are in the intensive care unit (ICU) for non-heart-related reasons. We will use data from past ICU patients (2008-2019) to compare three approaches: No magnesium treatment (even if levels are low); Daily magnesium treatment (regardless of daily levels); Dynamic treatment (only giving magnesium when daily tests show low levels). The goal is to find out which strategy is safest and most effective for this group of patients.

Detailed description

This is a target trial emulation (a type of observational study that mimics a clinical trial) using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (2008-2019). Inclusion criteria: Adults (≥18 years) admitted to the ICU, with serum magnesium \<1.7 mg/dL within 72 hours of admission, and no history of heart disease or cardiac surgery. Sample size: 12,887 patients. Interventions (simulated): Three magnesium replacement strategies (Never Treat, Always Treat, Dynamic Treat). Outcome: 28-day all-cause mortality (death from any cause). Analysis methods: We will use the G-formula (to handle time-varying factors that could affect results) and sensitivity analyses to check if findings are reliable.

Interventions

None listed

Study design

Observational model

COHORT

Time perspective

RETROSPECTIVE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

1. Age ≥ 18 years. 2. Admitted to the Intensive Care Unit (ICU). 3. Developed hypomagnesemia (Serum Magnesium \< 1.7 mg/dL) within the first 72 hours of ICU admission.

Exclusion criteria

1. Admitted due to cardiac or cardiosurgical causes (e.g., Cardiac Surgery Recovery Unit, CCU, CVICU). 2. Underwent cardiac surgery during hospitalization (identified by ICD-9/10 procedure codes). 3. Primary discharge diagnosis of major cardiac conditions (e.g., myocardial infarction, heart failure, arrhythmias).

Design outcomes

Primary

Measure	Time frame	Description
28-Day All-Cause Mortality	28 days after t0	Death from any cause within 28 days after t0 (t0 = the first time serum magnesium \<1.7 mg/dL is detected within 72 hours of hospital admission)

Countries

China

Outcome results