Association between estimated pulse wave velocity and 28-day all-cause mortality in septic patients: a multicenter retrospective study

Background Estimated pulse wave velocity (ePWV) is an independent predictor of cardiovascular mortality and a marker of vascular stiffness; however, its association with mortality among septic patients remains unclear. Thus, this study aims to clarify the relationship between ePWV at admission and 28-day all-cause mortality (ACM) in septic patients. Methods This retrospective study analyzed septic patients from three Chinese academic centers between September 2015 and July 2023. Patients were categorized into quartiles based on their admission ePWV. The primary outcome was 28-day ACM. Survival differences were assessed using Kaplan-Meier curves. Cox proportional hazards regression and restricted cubic splines (RCS) were employed to analyze the association between ePWV and 28-day ACM. Subgroup and interaction analyses were used to evaluate the robustness of the findings. Results A total of 7702 patients were included (median age: 70 years), with 4635 (60.2%) males. Kaplan-Meier analysis showed that patients with higher ePWV had significantly lower survival (log-rank P < 0.001). After full adjustment, elevated ePWV was independently associated with 28-day ACM (hazard ratio [HR] per unit: 1.105, 95% confidence interval [CI]: 1.038–1.177), with the highest quartile exhibiting a more than two-fold increased risk compared with the lowest (HR: 2.320, 95% CI: 1.438–3.743; P < 0.001 for both). RCS analysis revealed a generally positive trend, with mortality risk increasing progressively across most of the ePWV range. According to interaction tests, the association was consistent across most subgroups, with significant interactions for mechanical ventilation and heart failure. Conclusions Elevated ePWV at admission is a robust, independent predictor of 28-day ACM in septic patients. It likely reflects a combination of chronic vascular aging and acute sepsis–induced vascular dysfunction, serving as a valuable biomarker for early risk stratification and a potential indicator of a vascular-dominant sepsis phenotype.