Hoppe Phillip, Burfeindt Christian, Reese Philip C, Briesenick Luisa, Flick Moritz, Kouz Karim, Pinnschmidt Hans, Hapfelmeier Alexander, Sessler Daniel I, Saugel Bernd
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Clin Anesth. 2022 Aug;79:110715. doi: 10.1016/j.jclinane.2022.110715. Epub 2022 Mar 17.
Postinduction and intraoperative hypotension are associated with organ injury in non-cardiac surgery patients. Automated ambulatory blood pressure monitoring can identify chronic arterial hypertension and nocturnal blood pressure non-dipping. We tested the hypotheses that: a) chronic arterial hypertension and nocturnal non-dipping are independent risk factors for postinduction and intraoperative hypotension; and b) adding information on chronic arterial hypertension and nocturnal non-dipping improves hypotension prediction models based on readily available preoperative clinical information.
Prediction model development based on a secondary analysis of a prospective observational study.
German university medical center.
366 non-cardiac surgery patients who had preoperative automated ambulatory blood pressure monitoring.
Multivariable analyses to identify risk factors for postinduction and intraoperative hypotension. Area under receiver operating characteristics curves (AUROC) and likelihood-ratio tests to test whether adding information on chronic arterial hypertension and nocturnal non-dipping improves hypotension prediction models based on readily available preoperative clinical information.
Risk factors for postinduction hypotension were age in years (odds ratio: 1.06 (95% confidence interval: 1.03 to 1.10), P = 0.001), American Society of Anesthesiologists physical status class (1.85 (1.02 to 3.35), P = 0.043), preoperative use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (15.19 (1.76 to 131.46), P = 0.013), chronic arterial hypertension (2.54 (1.49 to 4.34), P = 0.001), and nocturnal non-dipping (3.61 (2.09 to 6.23), P < 0.001). The model's AUROC was 0.76 (95% confidence interval: 0.71 to 0.81) with and 0.67 (0.62 to 0.73) without information on chronic arterial hypertension and nocturnal non-dipping (P < 0.001). Risk factors for intraoperative hypotension were male sex (1.73 (1.07 to 2.80), P = 0.025), chronic arterial hypertension (4.35 (2.33 to 8.14), P < 0.001), and nocturnal non-dipping (3.56 (2.07 to 6.11), P < 0.001). The model's AUROC was 0.76 (0.70 to 0.81) with and 0.63 (0.57 to 0.69) without information on chronic arterial hypertension and nocturnal non-dipping (P < 0.001).
Chronic arterial hypertension and nocturnal non-dipping are independent risk factors for postinduction and intraoperative hypotension in non-cardiac surgery patients. Adding information on chronic arterial hypertension and nocturnal non-dipping moderately improved hypotension prediction models based on preoperative clinical information.
诱导后及术中低血压与非心脏手术患者的器官损伤相关。自动动态血压监测可识别慢性动脉高血压和夜间血压非勺型变化。我们检验了以下假设：a）慢性动脉高血压和夜间非勺型变化是诱导后及术中低血压的独立危险因素；b）添加慢性动脉高血压和夜间非勺型变化的信息可改善基于术前易于获得的临床信息的低血压预测模型。
基于前瞻性观察性研究的二次分析进行预测模型开发。
德国大学医学中心。
366例术前行自动动态血压监测的非心脏手术患者。
进行多变量分析以识别诱导后及术中低血压的危险因素。采用受试者操作特征曲线下面积（AUROC）和似然比检验，以检验添加慢性动脉高血压和夜间非勺型变化的信息是否能改善基于术前易于获得的临床信息的低血压预测模型。
诱导后低血压的危险因素包括年龄（岁）（比值比：1.06（95%置信区间：1.03至1.10），P = 0.001）、美国麻醉医师协会身体状况分级（1.85（1.02至3.35），P = 0.043）、术前使用血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂（15.19（1.76至131.46），P = 0.013）、慢性动脉高血压（2.54（1.49至4.34），P = 0.001）和夜间非勺型变化（3.61（2.09至6.23），P < 0.001）。有慢性动脉高血压和夜间非勺型变化信息时模型的AUROC为0.76（95%置信区间：0.71至0.81），无此信息时为0.67（0.62至0.73）（P < 0.001）。术中低血压的危险因素包括男性（1.73（1.07至2.80），P = 0.025）、慢性动脉高血压（4.35（2.33至8.14），P < 0.001）和夜间非勺型变化（3.56（2.07至6.11），P < 0.001）。有慢性动脉高血压和夜间非勺型变化信息时模型的AUROC为0.76（0.70至0.81），无此信息时为0.63（0.57至0.69）（P < 0.001）。
慢性动脉高血压和夜间非勺型变化是非心脏手术患者诱导后及术中低血压的独立危险因素。添加慢性动脉高血压和夜间非勺型变化的信息适度改善了基于术前临床信息的低血压预测模型。
