Chen Jiayi, Que Shuhao, Jin Guangyong, Zhu Ying, Ma Buqing, Hu Wei
The Intensive Care Medicine Department, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China.
Zhejing Chinese Medical University, The Second School of Clinical Medicine, Hangzhou, China.
BMC Cardiovasc Disord. 2025 Mar 7;25(1):162. doi: 10.1186/s12872-025-04602-1.
Central venous pressure (CVP) monitoring is critical for fluid management in critically ill patients. This study evaluated the impact of CVP monitoring on 1-year mortality in intensive care unit (ICU) patients with congestive heart failure (CHF).
Data from the Medical Information for Critical Care IV (MIMIC-IV) database were analyzed for ICU patients admitted for the first time with a stay > 24 h. Patients were categorized into CVP and no-CVP groups based on CVP measurement. Logistic regression analyses were performed, with propensity score matching (PSM) and overlap weighting (OW) to minimize confounding. Inflection point analysis using logistic regression was conducted in the CVP group. Patients were further stratified into early (≤ 24 h) and late (> 24 h) CVP monitoring groups for additional analysis.
Among 4,479 patients, 919 were in the CVP group and 3,560 in the no-CVP group. CVP monitoring was associated with lower 1-year mortality (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.62-0.91, p = 0.003). Early CVP monitoring (≤ 24 h) independently reduced 1-year mortality (OR = 0.68, 95% CI = 0.47-0.97, p = 0.032). Predictors of mortality included the lowest diastolic blood pressure, lowest blood glucose, highest blood chloride, and Acute Physiology Score III (APSIII) score within 24 h of admission.
Early CVP monitoring significantly improves 1-year survival in ICU patients with congestive heart failure. These findings underscore the value of timely hemodynamic assessments in critical care and warrant further prospective validation in diverse settings.
中心静脉压（CVP）监测对于危重症患者的液体管理至关重要。本研究评估了CVP监测对重症监护病房（ICU）中充血性心力衰竭（CHF）患者1年死亡率的影响。
对重症监护医学信息IV（MIMIC-IV）数据库中首次入院且住院时间>24小时的ICU患者数据进行分析。根据CVP测量结果将患者分为CVP组和非CVP组。进行逻辑回归分析，并采用倾向评分匹配（PSM）和重叠加权（OW）以尽量减少混杂因素。在CVP组中使用逻辑回归进行拐点分析。患者进一步分为早期（≤24小时）和晚期（>24小时）CVP监测组进行额外分析。
在4479例患者中919例在CVP组，3560例在非CVP组。CVP监测与较低的1年死亡率相关（比值比[OR]=0.75，95%置信区间[CI]=0.62-0.91，p=0.003）。早期CVP监测（≤24小时）独立降低1年死亡率（OR=0.68，95%CI=0.47-0.97，p=0.032）。死亡率的预测因素包括入院后24小时内的最低舒张压、最低血糖、最高血氯和急性生理评分III（APSIII）。
早期CVP监测显著提高了ICU充血性心力衰竭患者的1年生存率。这些发现强调了在重症监护中及时进行血流动力学评估的价值，并值得在不同环境中进行进一步的前瞻性验证。
