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Estimated pulse wave velocity improves risk stratification for all-cause mortality in patients with COVID-19.

ABSTRACT: Accurate risk stratification in COVID-19 patients consists a major clinical need to guide therapeutic strategies. We sought to evaluate the prognostic role of estimated pulse wave velocity (ePWV), a marker of arterial stiffness which reflects overall arterial integrity and aging, in risk stratification of hospitalized patients with COVID-19. This retrospective, longitudinal cohort study, analyzed a total population of 1671 subjects consisting of 737 hospitalized COVID-19 patients consecutively recruited from two tertiary centers (Newcastle cohort: n = 471 and Pisa cohort: n = 266) and a non-COVID control cohort (n = 934). Arterial stiffness was calculated using validated formulae for ePWV. ePWV progressively increased across the control group, COVID-19 survivors and deceased patients (adjusted mean increase per group 1.89 m/s, P < 0.001). Using a machine learning approach, ePWV provided incremental prognostic value and improved reclassification for mortality over the core model including age, sex and comorbidities [AUC (core model + ePWV vs. core model) = 0.864 vs. 0.755]. ePWV provided similar prognostic value when pulse pressure or hs-Troponin were added to the core model or over its components including age and mean blood pressure (p < 0.05 for all). The optimal prognostic ePWV value was 13.0 m/s. ePWV conferred additive discrimination (AUC: 0.817 versus 0.779, P < 0.001) and reclassification value (NRI = 0.381, P < 0.001) over the 4C Mortality score, a validated score for predicting mortality in COVID-19 and the Charlson comorbidity index. We suggest that calculation of ePWV, a readily applicable estimation of arterial stiffness, may serve as an additional clinical tool to refine risk stratification of hospitalized patients with COVID-19 beyond established risk factors and scores.

SUBMITTER: Stamatelopoulos K

PROVIDER: S-EPMC8511157 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Estimated pulse wave velocity improves risk stratification for all-cause mortality in patients with COVID-19.

Stamatelopoulos Kimon K Georgiopoulos Georgios G Baker Kenneth F KF Tiseo Giusy G Delialis Dimitrios D Lazaridis Charalampos C Barbieri Greta G Masi Stefano S Vlachogiannis Nikolaos I NI Sopova Kateryna K Mengozzi Alessandro A Ghiadoni Lorenzo L Schim van der Loeff Ina I Hanrath Aidan T AT Ajdini Bajram B Vlachopoulos Charalambos C Dimopoulos Meletios A MA Duncan Christopher J A CJA Falcone Marco M Stellos Konstantinos K

Scientific reports 20211012 1

Accurate risk stratification in COVID-19 patients consists a major clinical need to guide therapeutic strategies. We sought to evaluate the prognostic role of estimated pulse wave velocity (ePWV), a marker of arterial stiffness which reflects overall arterial integrity and aging, in risk stratification of hospitalized patients with COVID-19. This retrospective, longitudinal cohort study, analyzed a total population of 1671 subjects consisting of 737 hospitalized COVID-19 patients consecutively r ...[more]

PMID: 34642385

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Project description:BackgroundEstimated pulse wave velocity (ePWV) has been proposed as a potential approach to estimate carotid-femoral pulse wave velocity. However, the potential of ePWV in predicting all-cause mortality (ACM) and cardiovascular disease mortality (CVM) in the general population is unclear.MethodsWe conducted a prospective cohort study using the data of 33,930 adults (age ≥ 20 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 until the end of December 2019. The study outcomes included ACM and CVM. Survey-weighted Cox proportional hazards models were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) to determine the association between ePWV and ACM and CVM. To further investigate whether ePWV was superior to traditional risk factors in predicting ACM and CVM, comparisons between ePWV and the Framingham Risk Score (FRS) and Pooled Cohort Equations (PCE) models were performed. Integrated Discriminant Improvement (IDI) and Net Reclassification Improvement (NRI) were employed to analyze differences in predictive ability between models.ResultsThe weighted mean age of the 33,930 adults included was 45.2 years, and 50.28% of all participants were men. In the fully adjusted Cox regression model, each 1 m/s increase in ePWV was associated with 50% and 49% increases in the risk of ACM (HR 1.50; 95% CI, 1.45-1.54) and CVM (HR 1.49; 95% CI, 1.41-1.57), respectively. After adjusting for FRS, each 1 m/s increase in ePWV was still associated with 29% (HR 1.29; 95% CI, 1.24-1.34) and 34% (HR 1.34; 95% CI, 1.23-1.45) increases in the risk of ACM and CVM, respectively. The area under the curve (AUC) predicted by ePWV for 10-year ACM and CVM were 0.822 and 0.835, respectively. Compared with the FRS model, the ePWV model improved the predictive value of ACM and CVM by 5.1% and 3.8%, respectively, with no further improvement in event classification. In comparison with the PCE model, the ePWV model's ability to predict 10-year ACM and CVM was improved by 5.1% and 3.5%, and event classification improvement was improved by 34.5% and 37.4%.ConclusionsIn the U.S. adults, ePWV is an independent risk factor for ACM and CVM and is independent of traditional risk factors. In the general population aged 20 to 85 years, ePWV has a robust predictive value for the risk of ACM and CVM, superior to the FRS and PCE models. The predictive power of ePWV likely originates from the traditional risk factors incorporated into its calculation, rather than from an indirect association with measured pulse wave velocity.

Project description:BackgroundArterial stiffness is a significant determinant and evaluation of cardio-cerebrovascular disease and all-cause mortality risk in the stroke population. Estimated pulse wave velocity (ePWV) is a well-established indirect measure of arterial stiffness. We examined the association of ePWV with all-cause and cardio-cerebrovascular disease (CCD) mortality in the stroke population in a large sample of US adults.MethodsThe study design was a prospective cohort study with data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2014, between the ages of 18-85 years, with follow-up through December 31, 2019. 1,316 individuals with stroke among 58,759 participants were identified and ultimately, 879 stroke patients were included in the analysis. ePWV was calculated from a regression equation using age and mean blood pressure according to the following formula: ePWV = 9.587 - (0.402 × age) + [4.560 × 0.001 × (age2)] - [2.621 × 0.00001 × (age2) × MBP] + (3.176 × 0.001 × age × MBP) - (1.832 × 0.01 × MBP). Survey-weighted Cox regression models were used to assess the association between ePWV and all-cause and CCD mortality risk.ResultsThe high ePWV level group had a higher increased risk of all-cause mortality and CCD mortality compared to the low ePWV level group after fully adjusting for covariates. With an increase in ePWV of 1 m/s, the risk of all-cause and CCD mortality increased by 44%-57% and 47%-72% respectively. ePWV levels were linearly correlated with the risk of all-cause mortality (P for nonlinear = 0.187). With each 1 m/s increase in ePWV, the risk of all-cause mortality increased by 44% (HR 1.44, 95% CI: 1.22-1.69; P < 0.001). When ePWV was <12.1 m/s, an increase in ePWV per 1 m/s was associated with a 119% (HR 2.19, 95% CI: 1.43-3.36; P < 0.001) increase in CCD mortality risk; when ePWV was ≥12.1 m/s, an increase in ePWV per 1 m/s was not associated with in CCD mortality risk.ConclusionePWV is an independent risk factor for all-cause and CCD mortality in stroke patients. Higher levels of ePWV are associated with higher all-cause mortality and CCD mortality in stroke patients.

Project description:Extensive evidence underscores the potential of estimated pulse wave velocity (ePWV) as a robust tool for predicting disease prevalence and mortality. However, its comparative effectiveness in forecasting all-cause and cardiovascular disease (CVD) mortality, particularly among stroke populations, remains inadequately characterized in relation to the traditional Framingham Risk Score (FRS) model. This prospective study included 1202 individuals with stroke from the National Health and Nutrition Examination Survey conducted between 1999 and 2014, with comprehensive follow-up data. Survey-weighted Cox regression models were employed to examine the association between ePWV and the risks of all-cause and CVD mortality. Subgroup analyses were performed to evaluate the stability of ePWV in predicting these outcomes. A generalized additive model was utilized to explore the dose-response relationship between ePWV and mortality risk. Receiver operating characteristic curves were then used to assess and compare the prognostic capabilities of ePWV and FRS models for 10-year all-cause and CVD mortality. After adjustment for relevant covariates, each 1 m/s increase in ePWV was associated with a 44% and 65% increase in all-cause and CVD mortality, respectively. ePWV demonstrated consistent prognostic performance across the majority of stroke subpopulations. Notably, ePWV exhibited a nonlinear relationship with all-cause mortality (P for nonlinearity = .045) while maintaining a linear association with CVD mortality (P for nonlinearity = .293). Furthermore, ePWV outperformed the FRS model in predicting 10-year all-cause (Integrated Discrimination Improvement = 0.061, 95% confidence interval: 0.031-0.095, P = .007) and CVD mortality (95% confidence interval: 0.005-0.083, P = .02). ePWV is an independent risk factor for both all-cause and CVD mortality in individuals with stroke, demonstrating superior predictive value compared to the traditional FRS model for forecasting these outcomes.

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Estimated pulse wave velocity improves risk stratification for all-cause mortality in patients with COVID-19.

Publications

Estimated pulse wave velocity improves risk stratification for all-cause mortality in patients with COVID-19.

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