This retrospective MIMIC-IV cohort included 4,293 critically ill patients with acute heart failure; 1,561 received intravenous magnesium sulfate. Early administration meant initiation from six hours before to 24 hours after ICU admission. Compared with no early administration, magnesium was associated with lower 30-day mortality (adjusted hazard ratio 0.68, 95% confidence interval 0.56–0.82) and 90-day mortality (0.74, 0.63–0.86). Associations appeared strongest at the extremes of the systemic immune-inflammation index, but formal interaction testing was not significant. These subgroup findings are hypothesis-generating and require prospective validation.
Early intravenous magnesium was associated with lower mortality in this ICU acute heart failure cohort. The observational findings do not establish benefit, and interaction testing did not support differential associations across inflammatory-index strata.
Study limitation: Retrospective exposure comparisons remain vulnerable to confounding; exploratory subgroup patterns were not supported by significant interaction testing.
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