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December 12, 2023European Journal of Anaesthesiology

CON: The hypotension prediction index is not a validated predictor of hypotension

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Why the study?

Recent concerns were raised that predictive abilities of the commercial Hypotension Prediction Index algorithm may have been overstated due to potential selection bias.

Does the Hypotension Prediction Index (HPI) algorithm improve the prediction of hypotension compared to a simple MAP alarm threshold?

Comparison

HPI algorithm vs simple MAP alarm threshold in the range of 70 to 75 mmHg

Design

CON position paper

Authors

SVSimon Tilma VistisenJEJohannes Enevoldsen

Discussion

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Overview

HPI performance likely overstated by MAP selection bias; leaves open true incremental value pending unbiased validation.

Structured PICO

Does the Hypotension Prediction Index (HPI) algorithm improve the prediction of hypotension compared to a simple MAP alarm threshold?

I
Intervention
Hypotension Prediction Index (HPI) algorithm
C
Comparator
Simple mean arterial pressure (MAP) alarm threshold in the range of 70 to 75 mmHg
O
Outcome
Prediction of hypotension (mean arterial pressure below 65 mmHg)

The Hypotension Prediction Index may have overstated predictive abilities due to selection bias and requires re-validation before clinical use.

Cite This Study

Vistisen et al. (2023) studied this question.

synapsesocial.com/papers/6a77e5ddd2fa2470761f2c68https://doi.org/10.1097/eja.0000000000001939
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Performance of the hypotension prediction index as an indicator of hypotensive haemodynamic instability in surgical patients2026
  2. 2The hypotension prediction index versus mean arterial pressure in predicting intraoperative hypotension2025 · 17 citations
  3. 3Intraoperative hypotension prediction in cardiac and noncardiac procedures: is HPI truly worthwhile? A systematic review and meta-analysis2025 · 10 citations
  4. 4Discrimination and calibration properties of the hypotension probability indicator during cardiac and vascular surgery2019 · 49 citations
  5. 5Ability of the hypotension prediction index to predict hypotension in patients with septic shock in the intensive care unit2025