⌘+K

October 19, 2023Open Access

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

View Full Paper

Ask AI

Bookmark

Share

Key result

Elevated estimated pulse wave velocity (Quartile 4) was independently associated with a significantly increased risk of in-hospital mortality (HR 5.32) compared to lower levels in critically ill patients with chronic kidney disease and atherosclerotic heart disease.

Why the study?

Carotid-femoral pulse wave velocity predicts cardiovascular mortality and kidney injury, but the correlation between non-invasively estimated pulse wave velocity and mortality in critically ill patients with chronic kidney disease and atherosclerotic heart disease was unknown.

Does higher estimated pulse wave velocity (ePWV) predict increased in-hospital and one-year mortality in critically ill patients with coexisting chronic kidney disease and atherosclerotic heart disease?

Study Design

Type

Cohort (n=1,173)

Multicenter

No

Structured PICO

Does higher estimated pulse wave velocity (ePWV) predict increased in-hospital and one-year mortality in critically ill patients with coexisting chronic kidney disease and atherosclerotic heart disease?

P

Population

1,173 critically ill adults with coexisting chronic kidney disease and atherosclerotic heart disease admitted to the ICU, followed for up to one year.

E

Exposure

Higher estimated pulse wave velocity (ePWV) quartiles (Q3: 10.32 < ePWV ≤ 11.90 m/s; Q4: 11.90 < ePWV ≤ 30.63 m/s) calculated from age and mean arterial pressure

C

Comparator

Lower estimated pulse wave velocity (ePWV) quartiles (Q1: 2.92 ≤ ePWV ≤ 8.87 m/s; Q2: 8.87 < ePWV ≤ 10.32 m/s)

O

Outcome

In-hospital mortalityhard clinical

Main Result

Hazard Ratio: 5.32 (95% CI 1.92–14.71)

Absolute Event Rate: 13.7% vs 3.46%

p-value: p=0.010

Limitations

Retrospective study design using the MIMIC-IV database may introduce selection bias
Only included patients admitted to the ICU, limiting generalizability to non-ICU patients
Blood pressure values were acquired before vasopressin administration, which could have mitigated potential confounding effects
Did not investigate the specific causes of death in the patient cohort
Retrospective study design with potential selection bias
Only included patients with CKD and ASHD admitted to the ICU, limiting generalizability to non-ICU patients
Blood pressure values were acquired before vasopressin medication administration, which could have mitigated potential confounding effects
Did not investigate the cause of death in the patients

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.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Cui et al. (2023) conducted a cohort in Chronic kidney disease and atherosclerotic heart disease (n=1,173). Estimated pulse wave velocity (ePWV) vs. Lower ePWV (Quartile 2) was evaluated on In-hospital mortality (HR 5.32, 95% CI 1.92-14.71, p=0.010). Elevated estimated pulse wave velocity (Quartile 4) was independently associated with a significantly increased risk of in-hospital mortality (HR 5.32) compared to lower levels in critically ill patients with chronic kidney disease and atherosclerotic heart disease.

synapsesocial.com/papers/6a7a1016a51ded8e7b32865b https://doi.org/10.21203/rs.3.rs-3447752/v1

View Full Paper

Ask AI

Bookmark

Share