Early estimated pulse wave velocity as a prognostic marker in critically ill patients with hemorrhagic stroke: A retrospective analysis of the MIMIC-IV database.

BACKGROUND: The estimated pulse wave velocity (ePWV) calculated using chronological age and blood pressure has been used as a valuable measure of vascular aging. This study aimed to investigate the relationship between early ePWV and all-cause mortality in critically ill patients with hemorrhagic stroke. METHODS: This study included hemorrhagic stroke patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Participants were categorized into four quartiles based on the ePWV values. The primary outcome was 30-day mortality, and the secondary outcomes were 90-day and 1-year mortality. Cox proportional risk models and restricted cubic spline analyses were conducted to assess the hazard ratio (HR) and 95% confidence interval (CI) for the association between ePWV and outcomes. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of ePWV. RESULTS: For 30-day mortality, after adjusting for all confounders, the association remained significant with ePWV considered as a continuous variable (HR, 95% CI: 1.21 [1.16, 1.26]; p < 0.001). The HR with 95% CI for the second, third, and fourth quartile groups were 1.40 (1.07, 1.83), 1.82 (1.37, 2.42), and 3.15 (2.30, 4.32), respectively, compared to the first quartile group. Also, ePWV was found to have a linear relationship with 30-day mortality. Similar findings were found for 90-day mortality and 1-year mortality. When ePWV was incorporated into conventional disease severity scoring systems, the predictive performance of these systems was significantly improved. CONCLUSIONS: This study revealed that higher levels of early ePWV are significantly associated with increased all-cause mortality in critically ill patients with hemorrhagic stroke. ePWV may be a promising prognostic marker for critically ill patients with hemorrhagic stroke.