Hemodynamics, fluids & transfusion
Comparison of Differences in Cohort (Forward) and Case Control (Backward) Methodologic Approaches for Validation of the Hypotension Prediction Index
Authors' conclusion
Using 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.
Study context
- Population
- Patients from previously reported studies with Hypotension Prediction Index data4,152,124 measurements
- Participants
- 2,022 patients
- Comparison
- Forward vs backward analysis of the Hypotension Prediction Index
- Outcome
- AUC of the Hypotension Prediction Index to predict MAP <65 mmHg for at least 1 min
- Follow-up
- 5, 10, and 15 min in advance
Methodological detailsretrospective analysis of previously reported studies, backward (case control) vs forward (cohort) analysis
- Retrospective analysis of previously reported studies
- Backward (case control) vs forward (cohort) analysis
Performance
As reported in the abstract
AUC of the index predicting hypotension · 5, 10, 15 min in advance
| Test or model | AUC 5 min (95% CI) | AUC 10 min (95% CI) | AUC 15 min (95% CI) |
|---|---|---|---|
| Backward | 0.957 (0.947 to 0.964) | 0.933 (0.924 to 0.942) | 0.929 (0.918 to 0.938) |
| Forward | 0.923 (0.912 to 0.933) | 0.923 (0.911 to 0.933) | 0.926 (0.914 to 0.937) |
AUC 5 min (95% CI)
Backward0.957 (0.947 to 0.964)
Forward0.923 (0.912 to 0.933)
AUC 10 min (95% CI)
Backward0.933 (0.924 to 0.942)
Forward0.923 (0.911 to 0.933)
AUC 15 min (95% CI)
Backward0.929 (0.918 to 0.938)
Forward0.926 (0.914 to 0.937)
Further findings
- AUC of mean arterial pressure (MAP) predicting hypotension (forward analysis) · 5, 10, 15 min in advance
- 0.932 (0.920 to 0.940) · AUC 5 min (95% CI) · AUC 10 min (95% CI) 0.929 (0.918 to 0.938) · AUC 15 min (95% CI) 0.932 (0.921 to 0.940)
Other hemodynamic variables
- No variable other than MAP had an AUC >0.7
Variation in the index due to MAP
- R2
- 0.77
Original publication
Comparison of Differences in Cohort (Forward) and Case Control (Backward) Methodologic Approaches for Validation of the Hypotension Prediction Index. Anesthesiology. Published 1 April 2024. doi:10.
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