The relationship between estimated pulse wave velocity and 28-day mortality in patients with acute kidney injury combined with congestive heart failure: a retrospective cohort analysis of the MIMIC-IV database.

Background: Estimated pulse wave velocity (ePWV) is considered a standalone predictor of mortality in acute kidney injury (AKI) patients throughout their hospitalization. As ePWV increases, the all-cause mortality of heart failure patients increases. This research aimed to explore the connection between ePWV and 28-day mortality among patients diagnosed with AKI alongside congestive heart failure (CHF).

Methods: This study includes 12,119 patients with AKI combined with CHF from the MIMIC-IV database. The ePWV was categorized into a high group (>11.355 m/s) and a low group (≤11.355 m/s) based on the ROC curve cutoff value. To elucidate the discrepancy of survival outcomes between the groups, a Kaplan-Meier survival analysis was conducted. Cox proportional hazards regression models were used to analyze the interplay between ePWV and the risk of mortality within 28 days for the patients. To delve into the dose-response relationship, restricted cubic spline (RCS) model was employed. Stratified analyses were carried out to assess the influence of varying ePWV levels on 28-day mortality across diverse subpopulations.

Results: Survival analysis reveals that patients exhibiting high ePWV demonstrate a significantly reduced survival rate of 28-day in comparison to those with low ePWV. Moreover, after adjusting for covariates, a strong correlation exists between high ePWV and an increased risk of mortality within 28 days (HR = 1.87,95% CI = 1.68-2.08,  < 0.001). The RCS curve shows a linear increase in 28-day mortality with increasing ePWV levels ( for nonlinearity = 0.224).

Conclusion: ePWV was significantly associated with 28-day risk of death in patients with AKI-CHF and was a standalone forecasting factor of it.