Association between estimated pulse wave velocity and 30-day mortality in critically ill patients with atrial fibrillation: a cohort study based on the MIMIC-IV database

Background and objective: Estimated pulse wave velocity (ePWV) is widely recognized as a practical surrogate marker for carotid-femoral pulse wave velocity (cfPWV) and has been validated as a prognostic indicator for a variety of diseases. Nevertheless, the association between ePWV and the risk of 30-day mortality in intensive care unit (ICU) patients diagnosed with atrial fibrillation (AF) remains insufficiently understood. This study aims to investigate the correlation between ePWV and 30-day mortality in critically ill patients with AF. Methods A retrospective analysis was conducted utilizing data from the MIMIC-IV database, focusing on ICU patients with AF. Participants were categorized into two groups based on an ePWV cutoff value determined through receiver operating characteristic (ROC) curve analysis. The relationship between ePWV levels and 30-day mortality was evaluated using Kaplan-Meier survival analysis, Cox proportional-hazards models, and restricted cubic spline (RCS) regression. Additionally, subgroup analyses were performed to assess the influence of ePWV on 30-day mortality across various patient subgroups. Results A cohort of 9,179 critically ill patients with AF was analyzed. The 30-day all-cause mortality rate was observed to be 15.47%. Upon adjusting for confounding variables, ePWV persisted as an independent risk factor for 30-day mortality ( P <0.001). RCS modeling revealed a non-linear association between ePWV and 30-day all-cause mortality (non-linear P <0.001). Conclusions The study identified ePWV as an independent predictor of 30-day mortality among critically ill patients with AF. Early identification of high-risk patients through ePWV assessment may enable timely interventions and enhance clinical outcomes. Clinical trial number Not applicable.