Central venous pressure measurement is associated with improved outcomes in critically ill elderly patients: A propensity score matched cohort study based on the MIMIC-III database

To examine the association of early central venous pressure (ECVP) measurement with 28-day mortality in critically ill elderly patients. We used the Medical Information Mart for Intensive Care database to identify critically ill elderly patients. Multivariable logistic regression was used to control confounding effects and characterize the association between ECVP measurement and 28-day mortality. Propensity score matching and propensity score-based inverse probability of treatment weighting were employed to assess the robustness of our findings. 21,781 patients were included in our study, of which 2860 underwent central venous pressure measurement within 24 hours of intensive care unit admission (ECVP group). ECVP measurement was associated with lower 28-day mortality (odds ratio = 0.73, 95% Confidence Interval 0.634-0.84, P < .001). The ECVP group's in-hospital mortality and 1-year mortality were also significantly lower than those of the non-ECVP group. The ECVP patients had significantly shorter duration of intensive care unit stay and hospital stay. The ECVP patients received more intravenous fluid. The duration of mechanical ventilation and vasopressor use among ECVP patients was also shorter. The ECVP group lactate increase was significantly lower than the non-ECVP group. The mediating effect of lactate change was significant (P = .014 for the average causal mediation effect). ECVP measurement is associated with a decreased risk of 28-day mortality, and serum lactate change may proportionally mediate this beneficial effect.