Diagnostic Accuracy of Ultrasound‐Generated Inferior Vena Cava Collapsibility Index in the Prediction of Post‐Induction Hypotension During General Anaesthesia: A Systematic Review and Meta‐Analysis

ABSTRACT Introduction Post‐induction hypotension (PIH) is a common complication following anaesthetic induction and is associated with adverse perioperative outcomes. Ultrasound‐generated inferior vena cava collapsibility index (IVC‐CI) is a non‐invasive measure of volume status that may predict PIH. This systematic review and meta‐analysis evaluated the diagnostic accuracy of IVC‐CI in predicting PIH in adult, non‐obstetric patients undergoing general anaesthesia. Methods A systematic search of PubMed, Embase, and Cochrane Library (up to June 2024) identified studies reporting IVC‐CI as a predictor of PIH. Prospective and retrospective observational studies were included, while studies involving paediatric, obstetric, or hypotensive patients pre‐induction were excluded. The QUADAS‐2 tool assessed risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was utilised to assess certainty of evidence. Pooled diagnostic performance was measured via area under the receiver operating characteristic curve (AUROC). Meta‐regression explored heterogeneity across studies. Results Twenty‐three studies ( n = 1973) were included, with 16 studies ( n = 1585) providing AUROC data. The pooled AUROC for IVC‐CI in predicting PIH was 0.72 (95% CI, 0.64–0.80), indicating moderate diagnostic accuracy. High heterogeneity was observed ( I 2 = 94.4%). Meta‐regression showed no significant associations between AUROC and age, sex, American Society of Anesthesiologists status, or induction agents. Publication bias was identified (Egger's test, p < 0.001). The quality of evidence, as evaluated using the GRADE approach, was ‘very low’. Discussion IVC‐CI shows potential as a predictive tool for PIH; however, significant heterogeneity, inconsistent protocols, and publication bias limit its robustness. Standardised measurement methods and larger studies are needed to confirm its clinical utility. Conclusion Ultrasound‐generated IVC‐CI demonstrates moderate accuracy in predicting PIH and may assist in guiding pre‐induction management strategies, such as fluid administration or vasopressor use.