Key result
AHI-PI predicts hemodynamic instability with an AUC of 0.87.
Why the study?
Predicting the onset of hemodynamic instability before it occurs remains a sought-after goal in acute and critical care medicine to help clinicians prevent episodes of hemodynamic instability.
Does the Analytic for Hemodynamic Instability-Predictive Indicator (AHI-PI) predict episodes of hemodynamic instability in hospitalized adult patients undergoing continuous ECG monitoring?
Cohort (n=4,633)
No
Does the Analytic for Hemodynamic Instability-Predictive Indicator (AHI-PI) predict episodes of hemodynamic instability in hospitalized adult patients undergoing continuous ECG monitoring?
The AHI-PI ECG-based analytic accurately predicts episodes of hemodynamic instability with a median lead time of 1.1 hours, potentially allowing for earlier clinical intervention.
Background Predicting the onset of hemodynamic instability before it occurs remains a sought-after goal in acute and critical care medicine. Technologies that allow for this may assist clinicians in preventing episodes of hemodynamic instability (EHI). We tested a novel noninvasive technology, the Analytic for Hemodynamic Instability-Predictive Indicator (AHI-PI), which analyzes a single lead of electrocardiogram (ECG) and extracts heart rate variability and morphologic waveform features to predict an EHI prior to its occurrence. Methods Retrospective cohort study at a quaternary care academic health system using data from hospitalized adult patients between August 2019 and April 2020 undergoing continuous ECG monitoring with intermittent noninvasive blood pressure (NIBP) or with continuous intra-arterial pressure (IAP) monitoring. Results AHI-PI’s low and high-risk indications were compared with the presence of EHI in the future as indicated by vital signs (heart rate > 100 beats/min with a systolic blood pressure < 90 mmHg or a mean arterial blood pressure of < 70 mmHg). 4,633 patients were analyzed (3,961 undergoing NIBP monitoring, 672 with continuous IAP monitoring). 692 patients had an EHI (380 undergoing NIBP, 312 undergoing IAP). For IAP patients, the sensitivity and specificity of AHI-PI to predict EHI was 89.7% and 78.3% with a positive and negative predictive value of 33.7% and 98.4% respectively. For NIBP patients, AHI-PI had a sensitivity and specificity of 86.3% and 80.5% with a positive and negative predictive value of 11.7% and 99.5% respectively. Both groups performed with an AUC of 0.87. AHI-PI predicted EHI in both groups with a median lead time of 1.1 hours (average lead time of 3.7 hours for IAP group, 2.9 hours for NIBP group). Conclusions AHI-PI predicted EHIs with high sensitivity and specificity and within clinically significant time windows that may allow for intervention. Performance was similar in patients undergoing NIBP and IAP monitoring.
No takes yet. Share an insight, caveat, or question.
Benson et al. (2023) conducted a cohort in Hemodynamic instability (n=4,633). Analytic for Hemodynamic Instability-Predictive Indicator (AHI-PI) was evaluated on Prediction of episode of hemodynamic instability (AUC) (p=<0.0001). The Analytic for Hemodynamic Instability-Predictive Indicator (AHI-PI) predicted episodes of hemodynamic instability with an AUC of 0.87 and a median lead time of 1.1 hours.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: