缺血性中风患者估计脉搏波速度（ePWV）与院内及重症监护病房（ICU）28天死亡率之间的关联：对MIMIC-IV数据库的回顾性分析

Association between Estimated Pulse Wave Velocity (ePWV) and in-hospital and ICU 28-day mortality in ischemic stroke patients: A retrospective analysis of the MIMIC-IV database.

作者信息

Zhao Shuhe, Liu Mingjie, Zhang Minheng, Liu Hongwei, Chen Xuan, Wang Yu

机构信息

Department of Neurology, Taiyuan City Central Hospital, The Ninth Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi Province, China.

Department of Oncology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.

出版信息

PLoS One. 2025 Aug 12;20(8):e0328818. doi: 10.1371/journal.pone.0328818. eCollection 2025.

DOI:10.1371/journal.pone.0328818

PMID:40794762

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12342261/

Abstract

BACKGROUND

Ischemic stroke poses a substantial global health burden. Reliable biomarkers for risk stratification in critically ill stroke patients are lacking. This study investigates estimated pulse wave velocity (ePWV), a non-invasive measure of arterial stiffness, as a novel prognostic indicator for mortality in this population.

METHODS

This retrospective cohort study analyzed data from 3,408 adult ischemic stroke patients admitted to the ICU within the MIMIC-IV database. Patients were categorized by ePWV tertiles. The primary outcome was 28-day mortality (in-hospital and ICU). Multivariate Cox regression models were employed to assess the association between ePWV and mortality, adjusting for comprehensive clinical variables.

RESULTS

Of the 3,408 patients, 481 (14.1%) died within 28 days of hospitalization. Non-survivors demonstrated significantly higher ePWV values (11.19 vs. 10.57, P < 0.001). Multivariate analysis revealed that ePWV was an independent predictor of both in-hospital (HR = 1.16, 95% CI: 1.05-1.28, P = 0.0033) and ICU 28-day mortality (HR = 1.31, 95% CI: 1.16-1.48, P < 0.0001). Subgroup analyses revealed significant interactions between ePWV and atrial fibrillation for in-hospital mortality (P = 0.0498) and mechanical ventilation for ICU mortality (P = 0.0294). For in-hospital mortality, the ePWV-associated risk was higher in patients with atrial fibrillation (HR 1.19, 95% CI: 1.07-1.31) compared to those without (HR 1.10, 95% CI: 0.98-1.23). For ICU mortality, the ePWV-associated risk was higher in patients without mechanical ventilation (HR 1.45, 95% CI: 1.24-1.70) compared to those with (HR 1.26, 95% CI: 1.11-1.44).

CONCLUSION

ePWV is a promising biomarker for predicting mortality in critically ill ischemic stroke patients, particularly identifying high-risk subgroups with atrial fibrillation or those not receiving timely mechanical ventilation.

摘要

背景

缺血性中风给全球带来了沉重的健康负担。目前缺乏用于危重症中风患者风险分层的可靠生物标志物。本研究调查估计脉搏波速度（ePWV），一种评估动脉僵硬度的非侵入性指标，作为该人群死亡率的新型预后指标。

方法

这项回顾性队列研究分析了MIMIC-IV数据库中3408例入住重症监护病房（ICU）的成年缺血性中风患者的数据。根据ePWV三分位数对患者进行分类。主要结局是28天死亡率（院内及ICU内）。采用多变量Cox回归模型评估ePWV与死亡率之间的关联，并对综合临床变量进行校正。

结果

在3408例患者中，481例（14.1%）在住院28天内死亡。非幸存者的ePWV值显著更高（11.19对10.57，P<0.001）。多变量分析显示，ePWV是院内（HR=1.16，95%CI：1.05-1.28，P=0.0033）和ICU 28天死亡率（HR=1.31，95%CI：1.16-1.48，P<0.0001）的独立预测因素。亚组分析显示，ePWV与房颤在院内死亡率方面（P=0.0498）以及与机械通气在ICU死亡率方面（P=0.0294）存在显著交互作用。对于院内死亡率，房颤患者中与ePWV相关的风险高于无房颤患者（HR 1.19，95%CI：1.07-1.31）（无房颤患者HR 1.10，95%CI：0.98-1.23）。对于ICU死亡率，未接受机械通气患者中与ePWV相关的风险高于接受机械通气患者（HR 1.45，95%CI：1.24-1.70）（接受机械通气患者HR 1.26，95%CI：1.11-1.44）。