What is the clinical evidence from this study?

Study design: Cohort. Population: Critically ill patients (n=22035). Intervention: Baseline pulse pressure ≥51 mmHg vs. Baseline pulse pressure 46-51 mmHg. Primary outcome: All-cause in-hospital mortality (OR 1.50, 95% CI 1.25-1.80, p=<0.001).

What question did this study set out to answer?

The study aims to investigate how baseline pulse pressure correlates with mortality in critically ill patients.

June 12, 2026Open Access

Association between baseline pulse pressure and prognosis in critically ill patients: a retrospective cohort study

Q: What are the key findings of this study?

Baseline pulse pressure exhibited a U-shaped association with in-hospital mortality, with both low (<46 mmHg, OR 1.38) and high (≥51 mmHg, OR 1.50) levels significantly increasing mortality risk compared to the optimal range of 46-51 mmHg.

Q: What question did this study set out to answer?

The study aims to investigate how baseline pulse pressure correlates with mortality in critically ill patients.

YGYiFan GaoSir Run Run Shaw Hospital WSWei SuChina Academy of Engineering Physics YWYinshan WuSir Run Run Shaw Hospital

Key Result

Baseline pulse pressure exhibited a U-shaped association with in-hospital mortality, with both low (<46 mmHg, OR 1.38) and high (≥51 mmHg, OR 1.50) levels significantly increasing mortality risk compared to the optimal range of 46-51 mmHg.

Key Points

The study aims to investigate how baseline pulse pressure correlates with mortality in critically ill patients.
Retrospective cohort study analyzing 22,035 ICU patients from the MIMIC-IV database.
Multivariable logistic regression and survival analyses were performed to assess mortality risk by pulse pressure groups.
XGBoost was used for feature importance assessment, and RMST analysis validated results.
A U-shaped relationship was found between pulse pressure and mortality risk, with significant inflection at 49 mmHg.
Both lower (< 46) and higher (≥ 51) pulse pressure groups had increased risks of in-hospital and long-term mortality (P < 0.05).
Elderly and septic subgroups showed significant interactions, indicating a stronger association.

Study Design

Type

Cohort (n=22,035)

Multicenter

Structured PICO

Does baseline pulse pressure predict in-hospital and long-term mortality in critically ill patients?

Population

22,035 critically ill adult patients admitted to the ICU, with a mean age of 65.2 years, evaluated for the association between baseline pulse pressure and mortality.

Exposure

Baseline pulse pressure (PP) <46 mmHg or ≥51 mmHg (defined as the first recorded value after admission via invasive arterial catheter).

Comparator

Baseline pulse pressure of 46-51 mmHg (reference group).

Outcome

All-cause in-hospital mortality.hard clinical

Baseline pulse pressure exhibits a U-shaped nonlinear relationship with mortality in critically ill patients, with an optimal range of 46-51 mmHg, suggesting its utility as a simple prognostic marker.

Main Result

Odds Ratio: 1.5 (95% CI 1.25–1.8)

Absolute Event Rate: 9.9% vs 7.4%

p-value: p=<0.001

Limitations

Retrospective design cannot establish causality
Single database (MIMIC-IV) may introduce geographic bias and limit generalizability
Unmeasured confounding factors cannot be fully eliminated
Inherent biases in data collection
Missing data on pre-ICU fluid resuscitation, treatments at other hospitals, and indications for ICU admission
Only included mortality as an outcome, lacking data on other cardiovascular complications

Abstract

Abstract To investigate the association between baseline pulse pressure (PP) and mortality in critically ill patients. This cohort study analyzed 22,035 ICU patients from the MIMIC-IV database. Baseline PP was defined as the first recorded value after admission. Outcomes included in-hospital, 180-day, and 365-day all-cause mortality. Feature importance was assessed using XGBoost. The relationship between PP and mortality was modeled with smooth curve fitting and threshold analysis. Multivariable logistic regression and survival analyses were performed to compare mortality risk across PP groups. Subgroup analyses examined effect modifications. The restricted mean survival time (RMST) analysis validated the robustness of the results. PP holds certain clinical significance in predicting ICU outcomes. A U-shaped relationship was identified, with an inflection point at 49 mmHg (95% CI 46–51). Patients were categorized into three groups: < 46, 46–51, and ≥ 51 mmHg. Using the 46–51 mmHg group as reference, both lower and higher PP groups showed significantly increased risks of in-hospital ( P < 0.05) and long-term mortality ( P < 0.05). Significant interactions were observed in the elderly and septic subgroups. RMST analysis further confirmed the stability of the results. Baseline PP nonlinearly predicts mortality risk in ICU patients, with the optimal range being 46–51 mmHg. This association is stronger in elderly and septic patients.

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