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April 03, 2018; 90 (14) Disputes & Debates: Editors' Choice

Author response: Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage

Eric M. Liotta, Shyam Prabhakaran, Matthew B. Maas
First published April 2, 2018, DOI: https://doi.org/10.1212/WNL.0000000000005272
Eric M. Liotta
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Shyam Prabhakaran
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Matthew B. Maas
(Chicago)
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Author response: Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage
Eric M. Liotta, Shyam Prabhakaran, Matthew B. Maas
Neurology Apr 2018, 90 (14) 667; DOI: 10.1212/WNL.0000000000005272

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We appreciate the interest of Zheng et al. in our article on magnesium, hemostasis, and outcome in spontaneous intracerebral hemorrhage (SICH),1 and their efforts investigating the topic. It is exciting that they observed an association between lower admission serum magnesium (ASM) and greater 30-day mortality, which is consistent with our findings and provides additional confirmatory evidence of a true ASM effect. While Zheng et al. did not demonstrate an association between ASM and 3-month mortality, there are potential reasons for this difference between our studies. We analyzed 3-month outcome using an ordinal rather than a binary mortality approach1; it is possible the binary mortality approach missed a functional outcome effect. We also analyzed outcomes only in patients presenting within 6 hours of symptom onset and accounted for time from onset in our model. The morbid consequences of delayed medical attention in late-presenting patients may predispose them to future medical complications with an overwhelming effect on 3-month mortality. This would be consistent with our hypothesis of an acute hemostatic role of magnesium and literature, suggesting that neurologic deterioration occurs early (less than 12 hours)2 and neurologic causes of death in SICH occur before 30 days while medical causes of death occur later.3

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  • © 2018 American Academy of Neurology
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