Machine-learning Algorithm to Predict Hypotension Based on High-fidelity Arterial Pressure Waveform Analysis

• The ability to predict intraoperative hypotension may advance the ability to prevent hypotension-associated complications effectively

• The extent to which advanced waveform analysis of invasive arterial lines may provide meaningful forewarning remains unknown

What This Article Tells Us That Is New:

• A machine-learning algorithm based on thousands of arterial waveform features can identify an intraoperative hypotensive event 15 min before its occurrence with a sensitivity of 88% and specificity of 87%

• Further studies must evaluate the real-time value of such algorithms in a broader set of clinical conditions and patients

Background: With appropriate algorithms, computers can learn to detect patterns and associations in large data sets. The authors’ goal was to apply machine learning to arterial pressure waveforms and create an algorithm to predict hypotension. The algorithm detects early alteration in waveforms that can herald the weakening of cardiovascular compensatory mechanisms affecting preload, afterload, and contractility.

Methods: The algorithm was developed with two different data sources: (1) a retrospective cohort, used for training, consisting of 1,334 patients’ records with 545,959 min of arterial waveform recording and 25,461 episodes of hypotension; and (2) a prospective, local hospital cohort used for external validation, consisting of 204 patients’ records with 33,236 min of arterial waveform recording and 1,923 episodes of hypotension. The algorithm relates a large set of features calculated from the high-fidelity arterial pressure waveform to the prediction of an upcoming hypotensive event (mean arterial pressure < 65 mmHg). Receiver-operating characteristic curve analysis evaluated the algorithm’s success in predicting hypotension, defined as mean arterial pressure less than 65 mmHg.

Results: Using 3,022 individual features per cardiac cycle, the algorithm predicted arterial hypotension with a sensitivity and specificity of 88% (85 to 90%) and 87% (85 to 90%) 15 min before a hypotensive event (area under the curve, 0.95 [0.94 to 0.95]); 89% (87 to 91%) and 90% (87 to 92%) 10 min before (area under the curve, 0.95 [0.95 to 0.96]); 92% (90 to 94%) and 92% (90 to 94%) 5 min before (area under the curve, 0.97 [0.97 to 0.98]).

Conclusions: The results demonstrate that a machine-learning algorithm can be trained, with large data sets of high-fidelity arterial waveforms, to predict hypotension in surgical patients’ records.