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Risk Factors for Sub–therapeutic Serum Concentrations of Magnesium Sulfate in Severe Preeclampsia of Chinese Patients
Yanxia Yu
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6105-0114
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Pregnancy and Childbirth.
Background: Magnesium sulfate (MgSO4) is the standard drug for eclampsia prophylaxis and treatment. In China, the effective therapeutic serum magnesium level is 1.8–3.0 mmol/L. There is little information on how to achieve and maintain effective therapeutic concentrations. This study aimed to investigate risk factors for sub-therapeutic serum concentrations of MgSO4 in patients with severe preeclampsia.
Methods: Patients with severe preeclampsia who received MgSO4 intravenous infusion were retrospectively reviewed. The maternal demographic characteristics, regimens for the administration of MgSO4, and lab test results of patients were collected. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were conducted for the risk factors influencing the serum magnesium concentration.
Results: A total of 93 patients with severe preeclampsia were included in the study. 52 (55.91%) patients did not attain therapeutic serum magnesium levels. A multivariate logistic regression analysis identified creatinine clearance (Ccr), whether the loading dose was given, and measurement time of serum magnesium concentration (referring to the time from start of MgSO4 infusion to blood draw for serum sampling) as independent risk factors for sub-therapeutic serum magnesium concentration (P < 0.05). ROC curve analysis indicated that the continuous variable Ccr had a significant predictive value for the serum magnesium concentration, which resulted in a cutoff point of 133 mL/min; while measurement time had limited predictive value, with cutoff point of 2.375 h.
Conclusions: Ccr, whether the loading dose was given, and measurement time were independent risk factors for sub-therapeutic serum magnesium concentration. A loading dose of MgSO4 everytime before the maintenance dose, as well as the duration of MgSO4 maintenance dose of more than 2.375 hours are recommended for all the patients with severe PE. Routine evaluation of serum magnesium levels is a recommended practice for women with severe PE and whose Ccr is ≥ 133 mL/min.
Keywords
Severe preeclampsia, Magnesium sulfate, Risk factors, Receiver operating characteristic curve, Logistic regression
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CURRENT STATUS: Published
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Posted 24 Sep, 2020
No comments provided
Submission checks complete
On 19 Sep, 2020
Editorial decision: Minor revision
On 18 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 14 Sep, 2020
Review #1 received
Received 07 Sep, 2020
Reviewer #1 agreed
On 17 Aug, 2020
Reviewers invited
Invitations sent on 14 Aug, 2020
Editor assigned
On 13 Aug, 2020
Submission checks complete
On 12 Aug, 2020
Editor invited
On 12 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 30 Jun, 2020
Review #2 received
Received 29 Jun, 2020
Reviewer #2 agreed
On 12 Jun, 2020
Reviewer #1 agreed
On 03 Jun, 2020
Review #1 received
Received 03 Jun, 2020
Reviewers invited
Invitations sent on 27 May, 2020
Editor assigned
On 25 May, 2020
Submission checks complete
On 24 May, 2020
Editor invited
On 24 May, 2020
No comments provided
Editorial decision: Major revision
On 22 Apr, 2020
Review #2 received
Received 21 Apr, 2020
Reviewer #3 agreed
On 15 Apr, 2020
Reviewer #2 agreed
On 10 Apr, 2020
Review #1 received
Received 10 Apr, 2020
Reviewers invited
Invitations sent on 10 Apr, 2020
Reviewer #1 agreed
On 10 Apr, 2020
Editor assigned
On 06 Apr, 2020
Submission checks complete
On 05 Apr, 2020
Editor invited
On 05 Apr, 2020
First submitted
On 02 Apr, 2020
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This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Risk Factors for Sub–therapeutic Serum Concentrations of Magnesium Sulfate in Severe Preeclampsia of Chinese Patients
Yanxia Yu
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6105-0114
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 5
Posted 24 Sep, 2020
No comments provided
Submission checks complete
On 19 Sep, 2020
Editorial decision: Minor revision
On 18 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 14 Sep, 2020
Review #1 received
Received 07 Sep, 2020
Reviewer #1 agreed
On 17 Aug, 2020
Reviewers invited
Invitations sent on 14 Aug, 2020
Editor assigned
On 13 Aug, 2020
Submission checks complete
On 12 Aug, 2020
Editor invited
On 12 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 30 Jun, 2020
Review #2 received
Received 29 Jun, 2020
Reviewer #2 agreed
On 12 Jun, 2020
Reviewer #1 agreed
On 03 Jun, 2020
Review #1 received
Received 03 Jun, 2020
Reviewers invited
Invitations sent on 27 May, 2020
Editor assigned
On 25 May, 2020
Submission checks complete
On 24 May, 2020
Editor invited
On 24 May, 2020
No comments provided
Editorial decision: Major revision
On 22 Apr, 2020
Review #2 received
Received 21 Apr, 2020
Reviewer #3 agreed
On 15 Apr, 2020
Reviewer #2 agreed
On 10 Apr, 2020
Review #1 received
Received 10 Apr, 2020
Reviewers invited
Invitations sent on 10 Apr, 2020
Reviewer #1 agreed
On 10 Apr, 2020
Editor assigned
On 06 Apr, 2020
Submission checks complete
On 05 Apr, 2020
Editor invited
On 05 Apr, 2020
First submitted
On 02 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Pregnancy and Childbirth.
Background: Magnesium sulfate (MgSO4) is the standard drug for eclampsia prophylaxis and treatment. In China, the effective therapeutic serum magnesium level is 1.8–3.0 mmol/L. There is little information on how to achieve and maintain effective therapeutic concentrations. This study aimed to investigate risk factors for sub-therapeutic serum concentrations of MgSO4 in patients with severe preeclampsia.
Methods: Patients with severe preeclampsia who received MgSO4 intravenous infusion were retrospectively reviewed. The maternal demographic characteristics, regimens for the administration of MgSO4, and lab test results of patients were collected. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were conducted for the risk factors influencing the serum magnesium concentration.
Results: A total of 93 patients with severe preeclampsia were included in the study. 52 (55.91%) patients did not attain therapeutic serum magnesium levels. A multivariate logistic regression analysis identified creatinine clearance (Ccr), whether the loading dose was given, and measurement time of serum magnesium concentration (referring to the time from start of MgSO4 infusion to blood draw for serum sampling) as independent risk factors for sub-therapeutic serum magnesium concentration (P < 0.05). ROC curve analysis indicated that the continuous variable Ccr had a significant predictive value for the serum magnesium concentration, which resulted in a cutoff point of 133 mL/min; while measurement time had limited predictive value, with cutoff point of 2.375 h.
Conclusions: Ccr, whether the loading dose was given, and measurement time were independent risk factors for sub-therapeutic serum magnesium concentration. A loading dose of MgSO4 everytime before the maintenance dose, as well as the duration of MgSO4 maintenance dose of more than 2.375 hours are recommended for all the patients with severe PE. Routine evaluation of serum magnesium levels is a recommended practice for women with severe PE and whose Ccr is ≥ 133 mL/min.
Figure 1