Association Between Estimated Pulse Wave Velocity and 30 Day All-Cause Mortality in Patients with Acute Pancreatitis: a Retrospective Cohort Analysis of the MIMIC-IV Database

Background Estimated pulse wave velocity (ePWV) is a validated surrogate marker of arterial stiffness and has demonstrated robust prognostic value in various cardiovascular diseases. Acute pancreatitis (AP) is a prevalent and potentially life-threatening gastrointestinal disorder; however, to our knowledge, no prior study has investigated the prognostic significance of ePWV in this population. Methods We identified adult patients with AP admitted to the intensive care unit (ICU) from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. ePWV was calculated using an established formula based on age and mean arterial pressure (MAP) recorded on the first ICU day, and categorized patients into high- and low-ePWV groups based on the median value. The primary endpoint was 30-day all-cause mortality; secondary endpoints included 60- and 90-day mortality. The Kaplan–Meier method and multivariable Cox proportional-hazards models were applied to assess associations between ePWV and outcomes, and restricted cubic spline analysis was performed to explore the dose–response relationship. Results A total of 1,351 patients with AP were included (mean age, 51.2 years; 48.7% male). Patients in the high-ePWV group were older (64.3 vs. 37.8 years, P  < 0.001) and had significantly higher 30-, 60-, and 90-day mortality rates. In multivariable analysis, elevated ePWV was independently associated with an increased risk of 30-day mortality (hazard ratio, 2.12; 95% CI, 1.59–2.82; P  < 0.001). Restricted cubic spline analysis revealed a positive, dose–response association between ePWV and 30-day mortality, consistent across subgroups stratified by age, race, and hypertension status. Conclusion Elevated ePWV is independently associated with higher short-term mortality in patients with AP, supporting its potential role as a simple and readily obtainable prognostic biomarker in the ICU setting.