Association between early central venous pressure monitoring and 30-day mortality in critically ill patients with comorbid heart failure and sepsis: A retrospective cohort study

Central venous pressure (CVP) is widely used in the intensive care unit (ICU), but the optimal timing to initiate CVP monitoring remains unclear for patients with comorbid heart failure and sepsis. We explored the association between time to initial CVP measurement and 30-day mortality in this high-risk population. This retrospective cohort study included 9246 critically ill patients with comorbid heart failure and sepsis from the MIMIC-IV database. Restricted cubic spline (RCS) analysis examined the relationship between time to initial CVP measurement and 30-day mortality. Inverse probability of treatment weighting followed by weighted logistic regression was used to assess the association between early CVP monitoring (≤6 hours after ICU admission) and 30-day mortality. A nonlinear J-shaped association emerged, with the lowest risk at 2.89 hours post-admission. Early CVP monitoring was associated with lower 30-day mortality (OR = 0.816, 95% CI: 0.688–0.967, P = .019). A landmark sensitivity analysis comparing no monitoring, early (≤6 hours), intermediate (6–86 hours), and late (>86 hours) monitoring showed a time-dependent relationship: intermediate (OR = 1.396, 95% CI: 1.194–1.632, P < .001) and late monitoring (OR = 3.141, 95% CI: 2.263–4.359, P < .001) were associated with progressively higher mortality. In critically ill patients with comorbid heart failure and sepsis, early CVP monitoring within 6 hours of ICU admission was associated with lower 30-day mortality, while delayed monitoring carried an elevated risk. Early integration of CVP within a multimodal hemodynamic assessment framework may be a prudent approach in this high-risk population.