• Simon J Davies, Daniel I Sessler, Zhongping Jian, Neal W Fleming, Monty Mythen, Kamal Maheshwari, Denise P Veelo, VlaarAlexander P JAPJDepartments of Anaesthesia and Intensive Care, Amsterdam University Medical Center, Amsterdam, The Netherlands., Jos Settels, Thomas Scheeren, B J P van der Ster, Michael Sander, Maxime Cannesson, and Feras Hatib.
• Department of Anaesthesia, Critical Care and Perioperative Medicine, York and Scarborough Teaching Hospitals National Health Service Foundation Trust, York, United Kingdom; and Centre for Health and Population Science, Hull York Medical School, York, United Kingdom.
• Anesthesiology. 2024 Sep 1; 141 (3): 443452443-452.

BackgroundThe Hypotension Prediction Index (the index) software is a machine learning algorithm that detects physiologic changes that may lead to hypotension. The original validation used a case control (backward) analysis that has been suggested to be biased. This study therefore conducted a cohort (forward) analysis and compared this to the original validation technique.MethodsA retrospective analysis of data from previously reported studies was conducted. All data were analyzed identically with two different methodologies, and receiver operating characteristic curves were constructed. Both backward and forward analyses were performed to examine differences in area under the receiver operating characteristic curves for the Hypotension Prediction Index and other hemodynamic variables to predict a mean arterial pressure (MAP) less than 65 mmHg for at least 1 min 5, 10, and 15 min in advance.ResultsThe analysis included 2,022 patients, yielding 4,152,124 measurements taken at 20-s intervals. The area under the curve for the index predicting hypotension analyzed by backward and forward methodologies respectively was 0.957 (95% CI, 0.947 to 0.964) versus 0.923 (95% CI, 0.912 to 0.933) 5 min in advance, 0.933 (95% CI, 0.924 to 0.942) versus 0.923 (95% CI, 0.911 to 0.933) 10 min in advance, and 0.929 (95% CI, 0.918 to 0.938) versus 0.926 (95% CI, 0.914 to 0.937) 15 min in advance. No variable other than MAP had an area under the curve greater than 0.7. The areas under the curve using forward analysis for MAP predicting hypotension 5, 10, and 15 min in advance were 0.932 (95% CI, 0.920 to 0.940), 0.929 (95% CI, 0.918 to 0.938), and 0.932 (95% CI, 0.921 to 0.940), respectively. The R2 for the variation in the index due to MAP was 0.77.ConclusionsUsing an updated methodology, the study found that the utility of the Hypotension Prediction Index to predict future hypotensive events is high, with an area under the receiver operating characteristics curve similar to that of the original validation method.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc., on behalf of the American Society of Anesthesiologists.

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