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We aimed to develop and internally validate a simplified bedside score for continuous, minute-by-minute screening of low cardiac index using routinely available parameters. Retrospective single-centre study of adults undergoing major abdominal surgery with advanced haemodynamic monitoring (January 2023 to February 2026). Low cardiac index was defined as pulse contour cardiac index\u2009&lt;\u20092.2\u00a0l.min\n                    <jats:sup>\u2212\u20091<\/jats:sup>\n                    .m\n                    <jats:sup>\u2212\u20092<\/jats:sup>\n                    . The dataset was split 80\/20 at the patient level. Twelve candidate features were ranked using SHapley Additive exPlanations (SHAP) values; the top five were used to fit a generalised linear mixed model, yielding the integer-weighted Low Cardiac Index (LCI) score. A rule-out threshold (sensitivity\u2009\u2265\u20090.90) was selected, and test-set performance was evaluated with patient-level cluster bootstrap. The analysis cohort comprised 136 patients and 42,346 timepoints (15.5% low cardiac index prevalence). The derived formula was LCI score\u2009=\u200957 + (2 \u00d7 DBP) + (0.5 \u00d7 Age)\u2009+\u2009PPV \u2013 HR \u2013 SBP. At a threshold of \u2265\u200930, the score achieved an area under the receiver operating characteristic curve of 0.84 (95% confidence interval 0.75, 0.91), sensitivity 0.92 (0.80, 0.99), and negative predictive value 0.97 (0.92, 1.00). Performance was stable across 20 random splits and outperformed individual haemodynamic parameters. The LCI score is a simple bedside rule-out tool for low cardiac index, with a score below 30 yielding a negative predictive value of 0.97. External validation and prospective assessment of clinical impact are warranted.\n                  <\/jats:p>","DOI":"10.1007\/s10877-026-01482-4","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:47:14Z","timestamp":1786967234000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and internal validation of the Low Cardiac Index Score: a simplified bedside tool for continuous intraoperative screening"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0051-1850","authenticated-orcid":false,"given":"Karam","family":"Azem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5090-4935","authenticated-orcid":false,"given":"Philip","family":"Heesen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3890-1167","authenticated-orcid":false,"given":"Roussana","family":"Aranbitski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9545-4149","authenticated-orcid":false,"given":"Ariel","family":"Ronen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1143-4122","authenticated-orcid":false,"given":"Alexander","family":"Avidan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2147-7353","authenticated-orcid":false,"given":"Yair","family":"Binyamin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2218-6072","authenticated-orcid":false,"given":"Dror Ben","family":"Leviner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7196-7732","authenticated-orcid":false,"given":"Sharon","family":"Orbach-Zinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaul","family":"Lev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0930-8223","authenticated-orcid":false,"given":"Benjamin","family":"Zribi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4002-2074","authenticated-orcid":false,"given":"Shai","family":"Fein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"1482_CR1","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.bja.2019.03.027","volume":"123","author":"T Parker","year":"2019","unstructured":"Parker T, Brealey D, Dyson A, Singer M. 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Approval was granted by the Institutional Review Board of Rabin Medical Centre \u2013 Beilinson Hospital (Chairperson Prof. Ran Tur-Kaspa) in May 2023, approval number 0059-23-RMC.","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was waived by the Institutional Review Board due to the retrospective, non-interventional nature of the study.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the preparation of this work, the authors used \u201cClaude.AI\u201d for text and grammar correction. After using this tool, the authors reviewed and edited the content as needed and took full responsibility for the publication\u2019s content.","order":4,"name":"Ethics","label":"Declaration of generative AI and AI-assisted technologies in the writing process","group":{"name":"EthicsHeading","label":"Declarations"}}]}}