Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage

Eric M. Liotta*, Shyam Prabhakaran, Rajbeer S. Sangha, Robin A. Bush, Alan E. Long, Stephen A. Trevick, Matthew B. Potts, Babak S. Jahromi, Minjee Kim, Edward M. Manno, Farzaneh A. Sorond, Andrew M. Naidech, Matthew B. Maas

*Corresponding author for this work

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective: We tested the hypothesis that admission serum magnesium levels are associated with hematoma volume, hematoma growth, and functional outcomes in patients with intracerebral hemorrhage (ICH). Methods: Patients presenting with spontaneous ICH were enrolled in an observational cohort study that prospectively collected demographic, clinical, laboratory, radiographic, and outcome data. We performed univariate and adjusted multivariate analyses to assess for associations between serum magnesium levels and initial hematoma volume, final hematoma volume, and in-hospital hematoma growth as radiographic measures of hemostasis, and functional outcome measured by the modified Rankin Scale (mRS) at 3 months. Results: We included 290 patients for analysis. Admission serum magnesium was 2.0 ± 0.3 mg/dL. Lower admission magnesium levels were associated with larger initial hematoma volumes on univariate (p = 0.02), parsimoniously adjusted (p = 0.002), and fully adjusted models (p = 0.006), as well as greater hematoma growth (p = 0.004, p = 0.005, and p = 0.008, respectively) and larger final hematoma volumes (p = 0.02, p = 0.001, and p = 0.002, respectively). Lower admission magnesium level was associated with worse functional outcomes at 3 months (i.e., higher mRS; odds ratio 0.14, 95% confidence interval 0.03-0.64, p = 0.011) after adjustment for age, admission Glasgow Coma Scale score, initial hematoma volume, time from symptom onset to initial CT, and hematoma growth, with evidence that the effect of magnesium is mediated through hematoma growth. Conclusions: These data support the hypothesis that magnesium exerts a clinically meaningful influence on hemostasis in patients with ICH.

Original languageEnglish (US)
Pages (from-to)813-819
Number of pages7
JournalNeurology
Volume89
Issue number8
DOIs
StatePublished - Aug 22 2017

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Cerebral Hemorrhage
Hemostasis
Hematoma
Magnesium
Growth
Serum
Glasgow Coma Scale
Observational Studies
Cohort Studies
Multivariate Analysis
Odds Ratio
Demography
Confidence Intervals

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

@article{f1641e0ea8bf4153b00be0eca41210b3,
title = "Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage",
abstract = "Objective: We tested the hypothesis that admission serum magnesium levels are associated with hematoma volume, hematoma growth, and functional outcomes in patients with intracerebral hemorrhage (ICH). Methods: Patients presenting with spontaneous ICH were enrolled in an observational cohort study that prospectively collected demographic, clinical, laboratory, radiographic, and outcome data. We performed univariate and adjusted multivariate analyses to assess for associations between serum magnesium levels and initial hematoma volume, final hematoma volume, and in-hospital hematoma growth as radiographic measures of hemostasis, and functional outcome measured by the modified Rankin Scale (mRS) at 3 months. Results: We included 290 patients for analysis. Admission serum magnesium was 2.0 ± 0.3 mg/dL. Lower admission magnesium levels were associated with larger initial hematoma volumes on univariate (p = 0.02), parsimoniously adjusted (p = 0.002), and fully adjusted models (p = 0.006), as well as greater hematoma growth (p = 0.004, p = 0.005, and p = 0.008, respectively) and larger final hematoma volumes (p = 0.02, p = 0.001, and p = 0.002, respectively). Lower admission magnesium level was associated with worse functional outcomes at 3 months (i.e., higher mRS; odds ratio 0.14, 95{\%} confidence interval 0.03-0.64, p = 0.011) after adjustment for age, admission Glasgow Coma Scale score, initial hematoma volume, time from symptom onset to initial CT, and hematoma growth, with evidence that the effect of magnesium is mediated through hematoma growth. Conclusions: These data support the hypothesis that magnesium exerts a clinically meaningful influence on hemostasis in patients with ICH.",
author = "Liotta, {Eric M.} and Shyam Prabhakaran and Sangha, {Rajbeer S.} and Bush, {Robin A.} and Long, {Alan E.} and Trevick, {Stephen A.} and Potts, {Matthew B.} and Jahromi, {Babak S.} and Minjee Kim and Manno, {Edward M.} and Sorond, {Farzaneh A.} and Naidech, {Andrew M.} and Maas, {Matthew B.}",
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Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage. / Liotta, Eric M.; Prabhakaran, Shyam; Sangha, Rajbeer S.; Bush, Robin A.; Long, Alan E.; Trevick, Stephen A.; Potts, Matthew B.; Jahromi, Babak S.; Kim, Minjee; Manno, Edward M.; Sorond, Farzaneh A.; Naidech, Andrew M.; Maas, Matthew B.

In: Neurology, Vol. 89, No. 8, 22.08.2017, p. 813-819.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage

AU - Liotta, Eric M.

AU - Prabhakaran, Shyam

AU - Sangha, Rajbeer S.

AU - Bush, Robin A.

AU - Long, Alan E.

AU - Trevick, Stephen A.

AU - Potts, Matthew B.

AU - Jahromi, Babak S.

AU - Kim, Minjee

AU - Manno, Edward M.

AU - Sorond, Farzaneh A.

AU - Naidech, Andrew M.

AU - Maas, Matthew B.

PY - 2017/8/22

Y1 - 2017/8/22

N2 - Objective: We tested the hypothesis that admission serum magnesium levels are associated with hematoma volume, hematoma growth, and functional outcomes in patients with intracerebral hemorrhage (ICH). Methods: Patients presenting with spontaneous ICH were enrolled in an observational cohort study that prospectively collected demographic, clinical, laboratory, radiographic, and outcome data. We performed univariate and adjusted multivariate analyses to assess for associations between serum magnesium levels and initial hematoma volume, final hematoma volume, and in-hospital hematoma growth as radiographic measures of hemostasis, and functional outcome measured by the modified Rankin Scale (mRS) at 3 months. Results: We included 290 patients for analysis. Admission serum magnesium was 2.0 ± 0.3 mg/dL. Lower admission magnesium levels were associated with larger initial hematoma volumes on univariate (p = 0.02), parsimoniously adjusted (p = 0.002), and fully adjusted models (p = 0.006), as well as greater hematoma growth (p = 0.004, p = 0.005, and p = 0.008, respectively) and larger final hematoma volumes (p = 0.02, p = 0.001, and p = 0.002, respectively). Lower admission magnesium level was associated with worse functional outcomes at 3 months (i.e., higher mRS; odds ratio 0.14, 95% confidence interval 0.03-0.64, p = 0.011) after adjustment for age, admission Glasgow Coma Scale score, initial hematoma volume, time from symptom onset to initial CT, and hematoma growth, with evidence that the effect of magnesium is mediated through hematoma growth. Conclusions: These data support the hypothesis that magnesium exerts a clinically meaningful influence on hemostasis in patients with ICH.

AB - Objective: We tested the hypothesis that admission serum magnesium levels are associated with hematoma volume, hematoma growth, and functional outcomes in patients with intracerebral hemorrhage (ICH). Methods: Patients presenting with spontaneous ICH were enrolled in an observational cohort study that prospectively collected demographic, clinical, laboratory, radiographic, and outcome data. We performed univariate and adjusted multivariate analyses to assess for associations between serum magnesium levels and initial hematoma volume, final hematoma volume, and in-hospital hematoma growth as radiographic measures of hemostasis, and functional outcome measured by the modified Rankin Scale (mRS) at 3 months. Results: We included 290 patients for analysis. Admission serum magnesium was 2.0 ± 0.3 mg/dL. Lower admission magnesium levels were associated with larger initial hematoma volumes on univariate (p = 0.02), parsimoniously adjusted (p = 0.002), and fully adjusted models (p = 0.006), as well as greater hematoma growth (p = 0.004, p = 0.005, and p = 0.008, respectively) and larger final hematoma volumes (p = 0.02, p = 0.001, and p = 0.002, respectively). Lower admission magnesium level was associated with worse functional outcomes at 3 months (i.e., higher mRS; odds ratio 0.14, 95% confidence interval 0.03-0.64, p = 0.011) after adjustment for age, admission Glasgow Coma Scale score, initial hematoma volume, time from symptom onset to initial CT, and hematoma growth, with evidence that the effect of magnesium is mediated through hematoma growth. Conclusions: These data support the hypothesis that magnesium exerts a clinically meaningful influence on hemostasis in patients with ICH.

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DO - 10.1212/WNL.0000000000004249

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Liotta EM, Prabhakaran S, Sangha RS, Bush RA, Long AE, Trevick SA et al. Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage. Neurology. 2017 Aug 22;89(8):813-819. https://doi.org/10.1212/WNL.0000000000004249