Association of estimated pulse wave velocity with 28-day mortality in sepsis: A MIMIC-IV study.

INTRODUCTION

Despite the association between sepsis and carotid-femoral pulse wave velocity, the relationship between estimated pulse wave velocity (ePWV) and sepsis remains unclear. This study investigated the correlation between ePWV and 28-day mortality in patients with sepsis.

METHOD: Using data from the Medical Information Mart for Intensive Care IV database between 2008 and 2019, the association between ePWV and 28-day mortality was analysed with Kaplan-Meier curves, Cox models, and res-tricted cubic splines (RCS). Subgroup analysis was performed to validate the findings. A combined model was constructed by screening variables via Cox-least absolute shrinkage and selection operator (LASSO), with its incremental predictive value evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA).

RESULTS

Survival analysis showed an inverse association between ePWV and survival rates (log-rank test P<0.001). Cox analysis demonstrated that each increase in ePWV was associated with a significantly higher risk of 28-day mortality in patients with sepsis (hazard ratio 1.905, 95% confidence interval 1.672-2.169, P<0.001), with linearity confirmed by RCS analysis (P-nonlinear=0.3313). Subgroup analysis indicated significant interaction effects of invasive ventilation (P-interaction <0.001) and a history of malignant tumours (P-interaction =0.005) on mortality. The combined model optimised by LASSO demonstrated the best discriminative performance (ROC=0.823) and an improved net clinical benefit with the inclusion of ePWV, as confirmed by DCA.

CONCLUSION

ePWV was linearly and positively correlated with the risk of 28-day mortality in patients with sepsis.