Impact of early CVP monitoring on 1-year mortality in patients with congestive heart failure in the ICU: a retrospective analysis based on the MIMIC-IV2.2 database.

BACKGROUND

Central venous pressure (CVP) monitoring is critical for fluid management in critically ill patients. This study evaluated the impact of CVP monitoring on 1-year mortality in intensive care unit (ICU) patients with congestive heart failure (CHF).

METHODS

Data from the Medical Information for Critical Care IV (MIMIC-IV) database were analyzed for ICU patients admitted for the first time with a stay > 24 h. Patients were categorized into CVP and no-CVP groups based on CVP measurement. Logistic regression analyses were performed, with propensity score matching (PSM) and overlap weighting (OW) to minimize confounding. Inflection point analysis using logistic regression was conducted in the CVP group. Patients were further stratified into early (≤ 24 h) and late (> 24 h) CVP monitoring groups for additional analysis.

RESULTS

Among 4,479 patients, 919 were in the CVP group and 3,560 in the no-CVP group. CVP monitoring was associated with lower 1-year mortality (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.62-0.91, p = 0.003). Early CVP monitoring (≤ 24 h) independently reduced 1-year mortality (OR = 0.68, 95% CI = 0.47-0.97, p = 0.032). Predictors of mortality included the lowest diastolic blood pressure, lowest blood glucose, highest blood chloride, and Acute Physiology Score III (APSIII) score within 24 h of admission.

CONCLUSION

Early CVP monitoring significantly improves 1-year survival in ICU patients with congestive heart failure. These findings underscore the value of timely hemodynamic assessments in critical care and warrant further prospective validation in diverse settings.