Hemodynamics, fluids & transfusion
Challenging current evidence: Peripheral perfusion index fails as a predictor of postinduction hypotension – Findings from a large diverse surgical population
Authors' conclusion
Despite promising results from smaller studies, we found that preinduction PPI had no significant predictive value for PIH in a large, diverse surgical population.
Study context
- Population
- Adults undergoing GA, May 2022 to May 2023
- Participants
- 6,653 adults
- Exposure
- Preinduction peripheral perfusion index (PPI) as predictor of postinduction hypotension
- Outcome
- Predictive performance (AUC) of preinduction PPI for PIH (MAP < 65 mmHg within 20 min after induction)
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Predictive performance of preinduction PPI for PIH
Postinduction hypotension (PIH)
1.22
IQR 0.69–2.23
No PIH
1.23
IQR 0.75–2.13
P = 0.284
- AUC of PPI for PIH
- 0.51 (95 % CI 0.49-0.52)
- Sensitivity at optimal cutoff (0.81)
- 31 %
- Specificity at optimal cutoff (0.81)
- 72 %
Observational data: associations, not effects.
Further findings
Incidence of PIH
- Overall incidence of PIH
- 51.5 %
Discrimination across postinduction time intervals and subgroups (subgroup)
- Poor discrimination persisted across all time intervals and subgroups
Independent predictors of PIH (multivariable logistic regression)
- Preinduction MAP, advanced age, higher ASA physical status and emergency surgery were independent predictors
Original publication
Challenging current evidence: Peripheral perfusion index fails as a predictor of postinduction hypotension – Findings from a large diverse surgical population. J Clin Anesth. Published 14 August 2025. doi:10.
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