Machine Learning Model Based on Baroreflex Sensitivity for Predicting Post-Induction Hypotension in Elderly Patients

Development of a Baroreflex Sensitivity-Based Multifactorial Machine Learning Model for Predicting Post-Induction Hypotension in Elderly Patients

The purpose of this study is to develop a high-performance machine learning model combining dynamic baroreflex sensitivity (BRS) metrics and multi-dimensional static clinical features to predict the risk of post-induction hypotension (PIH) in elderly patients undergoing elective non-cardiac surgery under general anesthesia.

Study Overview

• Status: Recruiting
• Conditions: Post Induction Hypotension

Detailed Description

Aging significantly alters cardiovascular autonomic function, characterized by elevated sympathetic and decreased parasympathetic tone, rendering elderly patients highly vulnerable to post-induction hypotension (PIH). While existing machine learning models heavily rely on static data (e.g., baseline blood pressure, demographics, medication history), they lack real-time dynamic regulatory inputs, limiting their predictive performance in individualized care.

This single-center, prospective cohort study aims to bridge this gap by introducing preoperative BRS parameters-calculated via the continuous non-invasive arterial pressure (CNAP) method-into machine learning frameworks. A total of 500 patients aged over 65 years scheduled for elective non-cardiac surgery will be enrolled. Preoperative data, including autonomic indices, frailty assessments, and static clinical factors, will be mapped alongside intraoperative events and 30-day postoperative complications. Multiple machine learning algorithms (Logistic Regression, Random Forest, GBDT, XGBoost, LightGBM, and LSTM) will be leveraged and optimized using cross-validation to construct a robust clinical decision-support pipeline.

• Study Type: Observational
• Enrollment (Estimated): 500

Contacts and Locations

• Study Contact: Name: Quexuan Cui, Dr.; Phone Number: +8613520921711; Email: Cuiqx_garfield@126.com

Study Locations

• China
  • China
    • Beijing, China, China, 100730
      • Recruiting
      • Peking Union Medical College Hospital
      • Contact: Quexuan Cui; Phone Number: 13520921711; Email: Cuiqx_garfield@126.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients scheduled for elective operations

Description

Inclusion Criteria:

• Aged over 65 years;
• Scheduled for elective non-cardiac surgery;
• American Society of Anesthesiologists (ASA) physical status classification I-III;
• Planned for general anesthesia with endotracheal intubation;
• Patient and legal guardians are capable of understanding the study protocol and willing to provide written informed consent.

Exclusion Criteria:

• Severe peripheral vascular diseases;
• Secondary hypertension;
• Presence of physical tremors (e.g., Parkinson's disease) preventing stable recording;
• Inability to accurately measure upper limb blood pressure;
• Pre-existing cardiac arrhythmias (e.g., atrial fibrillation) that render BRS;
• Psychiatric disorders or cognitive impairments hindering basic cooperation.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Elderly Surgical Patients; Patients aged over 65 years who are undergoing elective non-cardiac surgery under general anesthesia with endotracheal intubation. All patients will receive continuous non-invasive hemodynamic monitoring prior to anesthesia induction to calculate baseline BRS parameters.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of Post-Induction Hypotension (PIH)	Defined as a systolic blood pressure (SBP) <90 mmHg , a mean arterial pressure (MAP) <65 mmHg, or a decrease in MAP exceeding 30% from baseline measurements.	From immediately after anesthesia induction up to 20 minutes post-induction or before surgical incision.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
1. Early Intraoperative Hypotension Rate	Defined as a systolic blood pressure (SBP) <90 mmHg , a mean arterial pressure (MAP) <65 mmHg, or a decrease in MAP exceeding 30% from baseline measurements.	From surgical incision to the end of the operation.
Postoperative Complication		Up to 30 days post-surgery

Collaborators and Investigators

• Sponsor: Peking Union Medical College Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): September 30, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: May 25, 2026
• First Submitted That Met QC Criteria: May 25, 2026
• First Posted (Actual): June 1, 2026

Study Record Updates

• Last Update Posted (Actual): June 1, 2026
• Last Update Submitted That Met QC Criteria: May 25, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: machine learning; elderly patient; baroreflex sensitivity; post-induction hypotension
• Other Study ID Numbers: 2025-PUMCH-A-119 (Other Grant/Funding Number: Peking Union Medical College Hospital)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No