Prognostic significance of early estimated pulse wave velocity trajectories in critically ill patients with intracerebral hemorrhage: a retrospective cohort study

This study aimed to identify distinct longitudinal trajectories of estimated pulse wave velocity (ePWV) during the acute phase of intracerebral hemorrhage (ICH) and to evaluate their association with 28-day mortality, comparing their prognostic value against a single baseline ePWV measurement. Adult patients with ICH admitted to the ICU were included. Latent class growth mixed modeling was applied to identify distinct ePWV trajectories. The primary outcome was 28-day all-cause mortality. Kaplan–Meier analysis and multivariable Cox proportional hazards models were used to assess the associations between ePWV trajectories and mortality. Among 3420 critically ill ICH patients included, four distinct ePWV trajectories were identified: Class 1 (initial decrease followed by an increase), Class 2 (stable moderate-to-high), Class 3 (stable low), and Class 4 (persistent decrease). Patients in Class 1 had the highest 28-day mortality rate, followed by Class 4. After adjusting for confounders, both Class 1 and Class 4 were independently associated with significantly increased mortality risk compared to Class 3. In contrast, a single initial ePWV measurement was not significantly associated with mortality after multivariable adjustment. Dynamic ePWV trajectories during the acute phase of ICH may provide additional prognostic information beyond a single baseline measurement. Specifically, Class 1 and Class 4 were independently associated with increased 28-day mortality, though these findings should be interpreted with caution given the limited sample size of certain trajectory classes.