Ripollés-Melchor HPI

Hemodynamic Management Guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial

Paziente / Popolazione Intervento / Esposizione Confronto Esito

In 917 patients aged ≥65 years (or >18 years with ASA physical status >II) undergoing moderate- to high-risk elective abdominal surgery at 28 hospitals, Hypotension Prediction Index-guided haemodynamic management did not reduce moderate-to-severe acute kidney injury within 7 days compared with real-world standard haemodynamic care.

N
917
Disegno
Multicentre RCT (28 hospitals)
Esito
Moderate-to-severe AKI within 7 days after surgery
Rilevanza
2
RisultatoModerate-to-severe AKI 6.1% vs 7.0% (RR 0.89, 95% CI 0.54–1.49; P=0.66); overall complications 31.9% vs 29.7% (RR 1.08, 95% CI 0.85–1.37; P=0.52); 30-day mortality 1.1% vs 0.9% (RR 1.35, 95% CI 0.36–5.10). Median stay 6 days in both groups.
Ripollés-Melchor J, et al. Anesthesiology. 2025;142(4):639-654. 10.1097/ALN.0000000000005355
Discussione e critica

The first HPI trial powered for a patient-centred outcome rather than hypotension burden, and it was negative: guided management did not reduce kidney injury, complications, stay or mortality. The comparator was a deliberately heterogeneous set of real-world haemodynamic strategies, and the abstract does not report how much hypotension was actually averted, so the trial cannot distinguish a failure of the index from a failure of the hypotension–AKI hypothesis. Together with Maheshwari HPI it tempers the surrogate-endpoint signal from HYPE.