Association between estimated pulse wave velocity and in-hospital and one-year mortality of patients with chronic kidney disease and atherosclerotic heart disease: a retrospective cohort analysis of the MIMIC-IV database

Abstract

Abstract Background Carotid-femoral pulse wave velocity has been identified as an autonomous predictor of cardiovascular mortality and kidney injury. This important clinical parameter can be non-invasively estimated using the calculated pulse wave velocity (ePWV). The objective of this study was to examine the correlation between ePWV and in-hospital as well as one-year mortality among critically ill patients with chronic kidney disease (CKD) and atherosclerotic heart disease (ASHD).Methods This study included a cohort of 1173 patients diagnosed with both CKD and ASHD, sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The four groups were compared using a Kaplan-Meier survival curve to assess variations in survival rates. Cox proportional hazards models were employed to analyze the correlation between ePWV and in-hospital as well as one-year mortality among critically ill patients with both CKD and ASHD. To further investigate the dose-response relationship, a restricted cubic splines (RCS) model was utilized. Additionally, stratification analyses were performed to examine the impact of ePWV on hospital and one-year mortality across different subgroups.Results The survival analysis results revealed a negative correlation between higher ePWV and survival rate. After adjusting for confounding factors, higher ePWV exhibited a statistically significant association with an increased risk of both in-hospital and one-year mortality among patients diagnosed with both CKD and ASHD (HR = 5.32, 95% CI = 1.92–14.71, P = 0.010; HR = 1.91, 95% CI = 1.07–3.39, P = 0.031). The analysis incorporating an RCS model confirmed a linear escalation in the risk of both in-hospital and one-year mortality with rising ePWV values (P for nonlinearity = 0.251; P for nonlinearity = 0.646).Conclusions Elevated ePWV was strongly correlated with an elevated mortality risk in patients diagnosed with both CKD and ASHD. Additionally, the ePWV was found to independently predict both in-hospital and one-year mortality in critically ill patients with coexisting CKD and ASHD.