{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:07:52Z","timestamp":1788847672035,"version":"build-2803163510"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post-induction hypotension (PIH) is a frequent perioperative complication during general anesthesia and adversely affects patient outcomes. Although machine-learning techniques have been widely applied to develop PIH prediction models, the methodological quality and predictive performance of existing models lack systematic evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically review the predictive performance, methodological quality, and common predictors of PIH prediction models in patients undergoing general anesthesia, and to provide evidence for clinical practice and future model development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, Web of Science, Cochrane Library, CNKI, and Wanfang Data were searched from inception to April 2026 for studies developing or validating PIH prediction models. 2 reviewers independently screened studies, extracted data, and assessed risk of bias using the Prediction model Risk of Bias Assessment Tool (PROBAST). A random-effects meta-analysis was performed for the area under the receiver operating characteristic curve (AUC). Pooled odds ratios (ORs) for predictors appearing in at least 3 studies were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>17 studies (50 prediction models, 40,864 patients) published between 2011 and 2026 were included. The AUC\/C-statistics reported by the modeling groups ranged from 0.68 to 0.95, and those reported by the validation groups ranged from 0.654 to 0.893, only 1 model was validated on an external institutional dataset (AUC 0.654). The pooled AUC of the 17 optimal models was 0.81 (95% CI 0.77\u20130.85). Age (OR 1.031, 95% CI 1.016\u20131.046) and propofol dose (OR 1.357, 95% CI 1.046\u20131.667) were significant risk predictors. PROBAST assessment rated 15 studies (88.2%) as having high overall risk of bias and 2 studies (11.8%) as low risk; most concerns arose from the statistical analysis domain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Current PIH prediction models show good discriminative ability, but most have a high risk of bias and lack external validation. Future research should standardize the definition of PIH, improve predictor selection, and conduct multicenter external validation to facilitate clinical translation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>CRD420261372822<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1887058","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:36:00Z","timestamp":1788845760000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prediction models for post-induction hypotension in patients undergoing general anesthesia: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Lu","family":"Meng","sequence":"first","affiliation":[{"name":"Department of Nursing, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanru","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuelai","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1093\/bja\/aex127","article-title":"Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia","volume":"119","author":"S\u00fcdfeld","year":"2017","journal-title":"Br J Anaesth"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"117","DOI":"10.4266\/acc.2023.00913","article-title":"Diagnostic accuracy of left ventricular outflow tract velocity time integral versus inferior vena cava collapsibility index in predicting post-induction hypotension during general anesthesia: an observational study","volume":"39","author":"Sharma","year":"2024","journal-title":"Acute Crit Care"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/EJA.0000000000002426","article-title":"Variation in postinduction hypotension 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