Ripollés-Melchor, JavierZorrilla-Vaca, AndrésEspinosa, Ángel V.Aldecoa, CésarLorente, Juan V.Monge-García, Manuel I.Quintana Villamandos, María BegoñaAbad Gurumeta, Alfredo2026-02-242026-02-242026-04Ripollés-Melchor J, Zorrilla-Vaca A, Espinosa ÁV, Aldecoa C, Quintana-Villamandos B, Abad-Gurumeta A, Lorente JV, Monge-García MI. Impact of hypotension prediction index-guided management on intraoperative hypotension and postoperative outcomes in abdominal surgery: A meta-analysis of randomized controlled trials. Anaesth Crit Care Pain Med. 2025 Oct 30;45(2):101656. doi: 10.1016/j.accpm.2025.101656. Epub ahead of print. PMID: 41175934.2352-556810.1016/j.accpm.2025.101656https://hdl.handle.net/20.500.14352/1330772025 Acuerdos transformativos CRUEBackground: The Hypotension Prediction Index (HPI) is a machine-learning algorithm designed to predict hypotension. by maintaining mean arterial pressure (MAP) above 65 mmHg. This meta-analysis evaluated whether HPI-guided management improves postoperative outcomes and included post hoc analyses of intraoperative hypotension (IOH) metrics in adults undergoing major abdominal surgery. Methods: A comprehensive search of PubMed, EMBASE, and Cochrane databases identified randomized controlled trials comparing HPI-guided management with standard care. Primary outcomes were postoperative complications, acute kidney injury (AKI), perioperative mortality, and hospital length of stay (LOS). Post hoc analyses assessed IOH metrics, including time-weighted average (TWA) of MAP < 65 mmHg, area under the threshold (AUT), total time with MAP < 65 mmHg, and intraoperative fluid use. Meta-analyses were conducted using random-effects models to calculate pooled standardized mean differences (SMDs), odds ratios (ORs), and mean differences (MDs). Results: Eight trials involving 1534 patients were included. No significant differences were observed for AKI (OR: 0.85; 95% CI: 0.64-1.13), postoperative complications (OR: 1.10; 95% CI: 0.83-1.46), mortality (OR: 0.96; 95% CI: 0.32-2.83), LOS (SMD: -0.15; 95% CI: -0.73 to 0.42), or fluid use (SMD: -0.06; 95% CI: -0.35 to 0.24). HPI reduced TWA MAP < 65 mmHg (SMD: -0.25; MD: -20.5 min), AUT (SMD: -0.83), and total time with MAP < 65 mmHg (SMD: -0.74). Conclusions: HPI-guided management did not significantly improve patient-centered outcomes. Post hoc analyses indicated a reduction in IOH metrics, but the clinical relevance of these findings remains uncertain given the lack of blinding and high risk of bias.engAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/journal articlehttps://doi.org/10.1016/j.accpm.2025.101656https://www.sciencedirect.com/science/article/pii/S2352556825001882?via%3Dihubopen access617Fluid therapy/methodsFluid therapy/statistics & numerical dataHemodynamics/physiologyPostoperative complications/epidemiologyCiencias Biomédicas32 Ciencias Médicas