Abstract
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. This retrospective study utilized the MIMIC-IV database to investigate the association between CVP trajectories in the first 24 h 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. 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. Distinct CVP trajectories during the early ICU period are associated with varying mortality risks in septic patients. Persistently elevated CVP trajectories may was associated with poor outcomes and warrants cautious fluid management.
Data availability
The datasets used and analyzed during the current study are publicly available in the MIMIC-IV database (https://physionet.org/content/mimiciv/). Analysis codes and materials are available from the corresponding author upon reasonable request.
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Acknowledgements
The authors gratefully acknowledge the Massachusetts Institute of Technology, Beth Israel Deaconess Medical Center, and all contributors to the MIMIC-IV database for providing open access to this valuable clinical resource.
Funding
This work was supported by the 2024 Public Welfare Research Guidance Project in the Field of Agriculture and Social Development (Grant No: 20241029Y088) and Zhejiang Provincial Traditional Chinese Medicine Science and Technology Project (Grant No: 2024ZL750) and the Construction Fund of Key Medical Disciplines of Hangzhou (Grant No: 2025HZZD04).
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Jiayi Chen and Shuhao Que contributed equally to this work. Jiayi Chen designed the study, performed data analysis, and drafted the manuscript. Shuhao Que participated in data extraction, statistical analysis, and figure preparation. Guangyong Jin and Buqing Ma assisted with data interpretation and revised the manuscript critically for important intellectual content. Wei Hu supervised the project and provided critical revisions. Hongwei Zhang contributed to the study design and final approval of the manuscript. All authors read and approved the final version of the manuscript.
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This study was a retrospective analysis using the publicly available MIMIC-IV v3.0 database (https://physionet.org/content/mimiciv/), which contains fully de-identified health-related data. The database has received prior approval from the Institutional Review Boards (IRBs) of the Massachusetts Institute of Technology (MIT, No. 0403000206) and Beth Israel Deaconess Medical Center (No. 2001-P-001699/14).
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Chen, J., Que, S., Jin, G. et al. Impact of central venous pressure trajectories on prognosis in ICU patients with sepsis. Sci Rep (2026). https://doi.org/10.1038/s41598-026-41213-y
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DOI: https://doi.org/10.1038/s41598-026-41213-y
