| Hypotension Prediction Index in the prediction of better outcomes: a systemic review and meta-analysis |
Yi Liu, Bei Liu, Wei Xiong, Chen Wang, Kunxin Yang, Wudi Ma, Liangtian Lan, Ming Wei, Nan Jiang, Xia Feng 
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Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China |
Corresponding author:
Nan Jiang, Tel: +86 20 87755766,
Email: jnan@mail.sysu.edu.cn
Xia Feng, Tel: +86 20 87755766,
Email: fengxia@mail.sysu.edu.cn
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Received: 28 March 2025 • Revised: 18 August 2025 • Accepted: 18 August 2025
*Yi Liu and Bei Liu contributed equally to this study as co-first authors. |
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| Abstract |
Background
The hypotension prediction index (HPI) is an algorithm designed to predict hypotension. Some studies have reported that HPI-guided hemodynamic management strategies decrease intraoperative hypotension and complications; however, the effect of HPI on reducing perioperative complications are controversial. This meta-analysis aimed to assess the efficacy of the HPI in reducing major complications and intraoperative hypotension.
Methods
We conducted this meta-analysis according to the PRISMA statement and Cochrane Handbook guidelines. A comprehensive literature review was conducted to identify studies focusing on the efficacy of HPI-guided management in reducing intraoperative hypotension and postoperative complications. The PubMed, Embase, Scopus, and Web of Science databases were searched, and the resulting data were combined to calculate the pooled mean differences (MDs) or risk ratios (RRs) with 95% CIs of both randomized controlled trials (RCTs) and retrospective studies, as appropriate. Heterogeneity and potential publication bias were also assessed.
Results
Nineteen articles (12 RCTs and 7 retrospective studies) with 2,570 recruited patients were included in this meta-analysis. The critical evaluation of the study quality revealed a low risk of bias in the included RCTs. Among the non-randomized trials, one was rated 7, two were rated 8, and the remaining four were rated 9 on the Newcastle-Ottawa Scale, indicating high quality and a low risk of bias. HPI-guided management significantly reduced intraoperative hypotension and associated major complications (RR = 0.79, 95% CI [0.69, 0.90], I2 = 0; P = 0.0005). Blood loss and length of hospital stay were comparable between the groups.
Conclusions
HPI-guided management significantly reduced intraoperative hypotension and major complications. |
| Key Words:
Complications; HPI; Hypotension prediction index; HPI-guided perioperative management; Intraoperative hypotension; Meta-analysis |
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