Association between estimated pulse wave velocity and in-hospital mortality risk in patients with sepsis-associated encephalopathy

Q: What are the key findings of this study?

Elevated estimated pulse wave velocity (≥ 10 m/s) was independently associated with an increased risk of in-hospital mortality in patients with sepsis-associated encephalopathy, yielding a pooled HR of 1.32.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Sepsis-associated encephalopathy (SAE) (n=6571). Intervention: High estimated pulse wave velocity (≥ 10 m/s) vs. Low estimated pulse wave velocity (< 10 m/s). Primary outcome: In-hospital mortality (HR 1.32, 95% CI 1.16-1.51).

Q: What does this research mean for the field?

Elevated estimated pulse wave velocity is independently associated with an increased risk of in-hospital mortality in patients with sepsis-associated encephalopathy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jia Song; 楚帅帅; Yin Cui; Yang Jiao; Zhengliang Ma

doi:10.1186/s12883-026-05493-1

October 9, 2026BMC NeurologyOpen Access

Association between estimated pulse wave velocity and in-hospital mortality risk in patients with sepsis-associated encephalopathy

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Key result

High ePWV linked to ~32% higher in-hospital mortality in sepsis-associated encephalopathy.

HR 1.32
95% CI 1.16-1.51
n=6,571

Why the study?

The relationship between estimated pulse wave velocity and in-hospital mortality in patients with sepsis-associated encephalopathy has not been elucidated.

Does high estimated pulse wave velocity (ePWV ≥ 10 m/s) predict increased in-hospital mortality in adult ICU patients with sepsis-associated encephalopathy?

Key Points

To elucidate the relationship between estimated pulse wave velocity, an indicator of arterial stiffness, and in-hospital mortality among intensive care unit patients with sepsis-associated encephalopathy.
Conducted a retrospective cohort study of 6571 ICU patients with sepsis-associated encephalopathy from two databases: MIMIC-IV (n=3623) and eICU-CRD (n=2948).
Calculated estimated pulse wave velocity (ePWV) using a validated formula based on age and mean blood pressure, categorizing patients into high and low groups at a threshold of 10 m/s.
Evaluated the association with in-hospital mortality using multivariable Cox proportional hazards regression and restricted cubic spline models adjusted for demographics, vital signs, laboratory values, comorbidities, severity scores, and interventions.
In-hospital mortality was 12.8% (464/3623) in the MIMIC-IV cohort and 18.59% (548/2948) in the eICU-CRD cohort.
Higher continuous ePWV was independently associated with increased in-hospital mortality, yielding an adjusted hazard ratio of 1.12 (95% CI 1.07–1.18; P < 0.001) in MIMIC-IV and 1.04 (95% CI 1.01–1.06; P = 0.001) in eICU-CRD.
Patients with high ePWV (≥ 10 m/s) exhibited significantly higher mortality compared to the low ePWV group, with adjusted hazard ratios of 1.37 (95% CI 1.11–1.7; P = 0.004) in MIMIC-IV and 1.29 (95% CI 1.09–1.53; P = 0.003) in eICU-CRD.

Study Design

Type

Cohort (n=6,571)

Multicenter

Yes

Structured PICO

Does high estimated pulse wave velocity (ePWV ≥ 10 m/s) predict increased in-hospital mortality in adult ICU patients with sepsis-associated encephalopathy?

P

Population

6,571 adult ICU patients aged 18 to 90 years with sepsis-associated encephalopathy from two large critical care databases, evaluated for in-hospital mortality.

E

Exposure

High estimated pulse wave velocity (ePWV) ≥ 10 m/s, calculated from age and mean arterial pressure (MAP) obtained in the first 24 hours post-ICU admission.

C

Comparator

Low estimated pulse wave velocity (ePWV) < 10 m/s.

O

Outcome

In-hospital mortality (defined as death from any cause during the index hospitalization).hard clinical

Main Result

Hazard Ratio: 1.32 (95% CI 1.16–1.51)

Limitations

No external validation beyond the two databases was performed.
ePWV was calculated from age and MAP measured during the first 24 hours, so pre-morbid blood pressure values were unavailable.
Unable to definitively separate the contribution of underlying chronic arterial stiffness from acute hemodynamic stress or treatment intensity.
ROC-derived cutpoints are intrinsically data-dependent and prone to instability and overfitting.

Implication

Elevated estimated pulse wave velocity is independently associated with an increased risk of in-hospital mortality in patients with sepsis-associated encephalopathy and improves risk stratification when added to standard severity scores.

Abstract

The estimated pulse wave velocity (ePWV) is a rapidly acquirable tool for assessing arterial stiffness and vascular elasticity. However, the relationship between ePWV and in-hospital mortality in patients with sepsis-associated encephalopathy (SAE) has not been elucidated. We conducted a cohort study involving 6571 participants diagnosed with SAE admitted to the ICU from the MIMIC-IV (v3.1) database and the eICU Collaborative Research Database (eICU-CRD). The calculation of ePWV relied on a validated formula dependent upon age and mean blood pressure. Considering ePWV's role in assessing cumulative vascular load, we classified the cohort according to ePWV levels (high/low) using a threshold of 10 m/s. Adjusted for clinical and laboratory variables, Cox proportional hazards models evaluated the relationship of ePWV to in-hospital mortality. We employed restricted cubic spline (RCS) analysis to examine potential non-linear effects. Model prediction was evaluated in terms of discrimination (AUC), calibration (calibration plot/Brier score), and overall performance (accuracy and precision). Furthermore, analyses of subgroups were performed according to the demographic and clinical characteristics. There were 3623 and 2948 patients in the MIMIC-IV and eICU-CRD cohorts, respectively. Higher ePWV was independently associated with increased in-hospital mortality, with adjusted hazard ratios of 1.12 (95%CI 1.07–1.18; P < 0.001) in MIMIC-IV cohort, 1.04 (95%CI 1.01–1.06; P = 0.001) in eICU-CRD cohort. In both cohorts, survival was significantly poorer in the high ePWV cohort according to Kaplan-Meier analysis ( P < 0.05). The RCS model suggested a positive linear link between ePWV and in-hospital mortality. Combining ePWV with other established risk scores improved discrimination, calibration, and clinical utility, surpassing the combined severity score model in both cohorts. Elevated ePWV is independently associated with increased risk of in-hospital mortality in patients with SAE. The application of ePWV can help clinicians achieve early warning of high-risk mortality cohort.

Discussion

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Cite This Study

Song et al. (2026) conducted a cohort in Sepsis-associated encephalopathy (SAE) (n=6,571). High estimated pulse wave velocity (≥ 10 m/s) vs. Low estimated pulse wave velocity (< 10 m/s) was evaluated on In-hospital mortality (HR 1.32, 95% CI 1.16-1.51). Elevated estimated pulse wave velocity (≥ 10 m/s) was independently associated with an increased risk of in-hospital mortality in patients with sepsis-associated encephalopathy, yielding a pooled HR of 1.32.

synapsesocial.com/papers/6acae65a082e6266f39bf601 https://doi.org/10.1186/s12883-026-05493-1

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Association between estimated pulse wave velocity and in-hospital mortality risk in patients with sepsis-associated encephalopathy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association between estimated pulse wave velocity and in-hospital mortality risk in patients with sepsis-associated encephalopathy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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