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April 8, 2025Anesthesiology

Prediction of Hypotension: Comment

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Why the study?

The authors responded to an editorial regarding the relationship between the Hypotension Prediction Index, mean arterial pressure, positive predictive values, and predicting hypotension.

Does the Hypotension Prediction Index accurately predict future hypotension compared to static mean arterial pressure values in surgical patients?

Population

1,683 surgical patients

Design

Letter to the editor analyzing pooled data

Follow-up

15 min

Authors

SDSimon DaviesUniversity of Nevada, Las VegasZJZhongping JianCardiac ImagingMMMonty MythenUniversity College Hospital

Discussion

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Member takes

Overview

Confirms HPI predictive performance under alternative methods; leaves open clinical utility pending outcome trials.

Structured PICO

Does the Hypotension Prediction Index accurately predict future hypotension compared to static mean arterial pressure values in surgical patients?

P
Population
1,683 surgical patients (pooled data from previous publications)
I
Intervention
Hypotension Prediction Index (HPI) alerts at a threshold of 85 or greater
C
Comparator
Mean arterial pressure (MAP) threshold (e.g., 72 mmHg) or single static MAP value
O
Outcome
Prediction of hypotension within the next 15 minutessurrogate

Evaluating Hypotension Prediction Index alerts rather than individual data points may provide a more clinically relevant assessment of its ability to predict impending hypotension.

Limitations

  • Interventions were not able to be accounted for with sufficient granularity, potentially underestimating positive predictive values
  • Use of single static values to predict future values may generate high AUC regardless of variable chosen

Cite This Study

Davies et al. (2025) studied this question.

synapsesocial.com/papers/6a7e45d2196d67da7483e2c7https://doi.org/10.1097/aln.0000000000005423
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Also Consider

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

  1. 1Machine-learning Algorithm to Predict Hypotension Based on High-fidelity Arterial Pressure Waveform Analysis2018 · 632 citations
  2. 2Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery2016 · 1,138 citations
  3. 3Shedding Needed Light on a Black Box Approach to Prediction of Hypotension2024 · 12 citations
  4. 4Hypotension Prediction Index Is Equally Effective in Predicting Intraoperative Hypotension during Noncardiac Surgery Compared to a Mean Arterial Pressure Threshold: A Prospective Observational Study2024 · 57 citations
  5. 5Comparison of Differences in Cohort (Forward) and Case Control (Backward) Methodologic Approaches for Validation of the Hypotension Prediction Index2024 · 42 citations