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Association of estimated pulse wave velocity with 28-day mortality in sepsis: A MIMIC-IV study

Xiuxiu Ding1, Chaochao Wei1,2,3, Shuang Cai1

  • 1Department of Respiratory and Critical Care Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, China.

Annals of the Academy of Medicine, Singapore
|June 6, 2026
PubMed
Abstract

Insights

Higher estimated pulse wave velocity (ePWV) is linked to increased 28-day mortality risk in sepsis patients. This finding highlights ePWV as a potential predictor for sepsis outcomes.

Area of Science:

  • Cardiovascular Physiology
  • Critical Care Medicine
  • Medical Informatics

Background:

  • Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
  • Carotid-femoral pulse wave velocity (cf-PWV) is a marker of arterial stiffness, but its association with sepsis outcomes is not well-established.
  • Estimated pulse wave velocity (ePWV) offers a non-invasive method to assess arterial stiffness.

Purpose of the Study:

  • To investigate the correlation between estimated pulse wave velocity (ePWV) and 28-day mortality in patients diagnosed with sepsis.
  • To determine if ePWV can serve as a predictive biomarker for mortality in sepsis.

Main Methods:

  • Utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (2008-2019).
  • Employed Kaplan-Meier curves, Cox proportional hazards models, and restricted cubic splines (RCS) to analyze the association between ePWV and 28-day mortality.
  • Constructed and validated a combined predictive model using Cox-least absolute shrinkage and selection operator (LASSO), receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).

Main Results:

  • Survival analysis revealed an inverse association between ePWV and survival rates (log-rank P<0.001).
  • Each unit increase in ePWV significantly elevated the risk of 28-day mortality in sepsis patients (HR 1.905, P<0.001), with a linear relationship confirmed by RCS.
  • Subgroup analyses identified significant interactions between invasive ventilation and malignant tumor history with mortality risk.
  • The LASSO-optimized combined model incorporating ePWV showed superior discriminative performance (ROC=0.823) and improved clinical utility via DCA.

Conclusions:

  • Estimated pulse wave velocity (ePWV) is linearly and positively correlated with an increased risk of 28-day mortality in sepsis patients.
  • ePWV demonstrates potential as a valuable prognostic biomarker for predicting mortality in sepsis.
  • The inclusion of ePWV in predictive models enhances their accuracy and clinical decision-making capabilities for sepsis management.
Keywords:
28-day mortalityMIMIC-IVePWVsepsis

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