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Titel:

Chronic arterial hypertension and nocturnal non-dipping predict postinduction and intraoperative hypotension: A secondary analysis of a prospective study.

Dokumenttyp:
Article; Journal Article; Observational Study
Autor(en):
Hoppe, Phillip; Burfeindt, Christian; Reese, Philip C; Briesenick, Luisa; Flick, Moritz; Kouz, Karim; Pinnschmidt, Hans; Hapfelmeier, Alexander; Sessler, Daniel I; Saugel, Bernd
Abstract:
STUDY OBJECTIVE: 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. DESIGN: Prediction model development based on a secondary analysis of a prospective observational study. SETTING: German university medical center. PATIENTS: 366 non-cardiac surgery patients who had preoperative automated ambulatory blood pressure monitoring. MEASUREMENTS: 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. MAIN RESULTS: 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). CONCLUSIONS: 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.
Zeitschriftentitel:
J Clin Anesth
Jahr:
2022
Band / Volume:
79
Volltext / DOI:
doi:10.1016/j.jclinane.2022.110715
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/35306353
Print-ISSN:
0952-8180
TUM Einrichtung:
Institut für KI und Informatik in der Medizin; Lehrstuhl für Allgemeinmedizin (Prof. Schneider) (keine SAP-Zuordnung!)
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