• Santino R Rellum, Eline Kho, Jimmy Schenk, Björn J P van der Ster, VlaarAlexander P JAPJ, and Denise P Veelo.
• From the Department of Anaesthesiology (SRR, EK, JS, BJPvdS, DPV), Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences (SRR, EK, JS, APJV) and Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands (JS).
• Eur J Anaesthesiol. 2024 Oct 15.

BackgroundClinical trials and validation studies demonstrate promising hypotension prediction capability by the Hypotension Prediction Index (HPI). Most studies that evaluate HPI derive it from invasive blood pressure readings, but a direct comparison with the noninvasive alternative remains undetermined. Such a comparison could provide valuable insights for clinicians in deciding between invasive and noninvasive monitoring strategies.ObjectivesEvaluating predictive differences between HPI when obtained through noninvasive versus invasive blood pressure monitoring.DesignPost hoc analysis of a prospective observational study conducted between 2018 and 2020.SettingSingle-centre study conducted in an academic hospital in the Netherlands.PatientsAdult noncardiac surgery patients scheduled for over 2 h long elective procedures. After obtaining informed consent, 91 out of the 105 patients had sufficient data for analysis.Main Outcome MeasuresThe primary outcome was the difference in area under the receiver-operating characteristics (ROC) curve (AUC) obtained for HPI predictions between the two datasets. Additionally, difference in time-to-event estimations were calculated.ResultsAUC (95% confidence interval (CI)) results revealed a nonsignificant difference between invasive and noninvasive HPI, with areas of 94.2% (90.5 to 96.8) and 95.3% (90.4 to 98.2), respectively with an estimated difference of 1.1 (-3.9 to 6.1)%; P = 0.673. However, noninvasive HPI demonstrated significantly longer time-to-event estimations for higher HPI values.ConclusionNoninvasive HPI is reliably accessible to clinicians during noncardiac surgery, showing comparable accuracy in HPI probabilities and the potential for additional response time.Trial RegistrationClinicaltrials.gov (NCT03795831) on 10 January 2019. https://clinicaltrials.gov/study/NCT03795831.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology.

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