Association Between Central Venous Pressure Trajectories Within the First 24 Hours of ICU Admission and Prognosis in Sepsis Patients: A Group-Based Trajectory Modeling Study Based on the MIMIC-IV 3.0 Database

Background Sepsis is a life-threatening condition characterized by organ dysfunction due to a dysregulated host response to infection. Optimal fluid resuscitation remains a challenge in sepsis management, and central venous pressure (CVP) is often used as a surrogate marker to guide therapy. However, the prognostic value of dynamic CVP changes remains unclear. Methods This retrospective study utilized the MIMIC-IV database to investigate the association between CVP trajectories in the first 24 hours of ICU admission and outcomes in septic patients. Group-based trajectory modeling (GBTM) was used to identify distinct CVP change patterns. Patients were stratified into four trajectory groups. Baseline characteristics, survival outcomes, and logistic regression analyses were conducted. Results A total of 3,068 patients were included. Four CVP trajectory groups were identified. Kaplan-Meier analysis showed significant differences in ICU, in-hospital, and long-term mortality (28-day, 60-day, 90-day, 180-day, and 1-year) across groups (log-rank p < 0.001). Multivariate logistic regression revealed that patients in the highest CVP trajectory group had significantly increased mortality compared to the lowest group. Subgroup analyses confirmed a consistent trend, with elevated CVP associated with worse prognosis. Conclusion Distinct CVP trajectories during the early ICU period are associated with varying mortality risks in septic patients. Persistently elevated CVP may indicate poor outcomes and warrants cautious fluid management.