Association between estimated pulse wave velocity and in-hospital mortality of patients with acute kidney injury: a retrospective cohort analysis of the MIMIC-IV database

Abstract

Background

Estimated pulse wave velocity (ePWV) has been found to be an independent predictor of cardiovascular mortality and kidney injury, which can be estimated noninvasively. This study aimed to investigate the association between ePWV and in-hospital mortality in critically ill patients with acute kidney injury (AKI).

Methods

This study included 5960 patients with AKI from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The low and high ePWV groups were compared using a Kaplan-Meier survival curve to evaluate the differences in survival status. Cox proportional hazards models were used to explore the association between ePWV and in-hospital mortality in critically ill patients with AKI. To further examine the dose-response relationship, we used a restricted cubic spline (RCS) model. Stratification analyses were conducted to investigate the effect of ePWV on hospital mortality across various subgroups.

Results

Survival analysis indicated that patients with high ePWV had a lower survival rate than those with low ePWV. Following adjustment, high ePWV demonstrated a statistically significant association with an increased risk of in-hospital mortality among AKI patients (HR = 1.53, 95% CI = 1.36-1.71, p < 0.001). Analysis using the RCS model confirmed a linear increase in the risk of hospital mortality as the ePWV values increased (P for nonlinearity = 0.602).

Conclusions

A high ePWV was significantly associated with an increased risk of in-hospital mortality among patients with AKI. Furthermore, ePWV was an independent predictor of in-hospital mortality in critically ill patients with AKI.

Keywords:

• Acute kidney injury
• estimated pulse wave velocity
• in-hospital mortality
• MIMIC-IV database

Author contributions

This work was written by Xinhai Cui and Yuanlong Hu who contributed equally to this work. Data were collected by Dongxiao Li, Mengkai Lu, and Zhiyuan Zhang. Chao Li and Dongfang Kan approved the final version of this manuscript. All the authors have read and agreed to the published version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical disclosures

The study was approved by the Institutional Review Boards of the Massachusetts Institute of Technology and Beth Israel Deaconess Medical Center.

Data availability statement

The data supporting the findings of this study are available from the first author upon reasonable request.

Additional information

Funding

This research was supported by National Nature Science Foundation of China (No. 82004276), Natural Science Foundation of Shandong Province (No. ZR2020QH305), Joint Fund Project of Natural Science Foundation of Shandong Province (No. ZR2021LZY022), and Shandong Provincial Medical and Health Science and Technology Development Program (No. 2019WS552). In addition, we would like to acknowledge the conference where an earlier version of this work was presented in the form of an abstract. We extend our gratitude to the ‘The 34th Great Wall International Congress of Cardiology Asian Heart Society Congress 2023’ held at Beijing, China on 7 September 2023. The abstract was made available online through ‘Cardiovascular Innovations and Applications 2023;8(s1):C1-C207’ and can be accessed via the following link: https://www.scienceopen.com/hosted-document? doi = 10.15212%2FCVIA.2023.0059.