{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T18:13:10Z","timestamp":1788545590813,"version":"build-2803163510"},"reference-count":48,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Intraoperative hypotension is an established risk factor for postoperative acute kidney injury (AKI), but whether arterial waveform morphology adds prognostic information beyond the hypotension burden is unknown. Methods: In this study, 2587 adult surgical cases from the Vital Signs Database (VitalDB) with continuous invasive arterial waveforms and creatinine-based (KDIGO) AKI ascertainment were analyzed retrospectively. Maximal systolic upstroke (dP\/dtmax), a late-diastolic pressure-decay descriptor (\u03c4), and a waveform-derived dynamic arterial elastance (Eadyn), modeled as latent-class trajectories and as case-level features, were added to a base logistic model of log-transformed hypotension burden (time-weighted MAP &lt; 65 mmHg), age, sex, and baseline eGFR. Results: AKI occurred in 143 cases (5.5%); the base model had an AUC of 0.725 (95% CI 0.680\u20130.770). A five-class dP\/dtmax solution yielded distinct phenotypes whose membership was nominally associated with AKI (likelihood-ratio p = 0.02) but did not improve discrimination (change in AUC (\u0394AUC), 0.008, 95% CI \u22120.005 to 0.021; optimism-corrected 0.002), and the association was attenuated after clinical adjustment (p = 0.13); \u03c4 showed no stable trajectory structure. No feature improved discrimination: the optimism-corrected \u0394AUC was \u22640.007, upper confidence limits did not exceed 0.03 on any adequately fitting reference model, and the signal disappeared after adjustment for procedure type and comorbidity. The likelihood-ratio test had 80% power for a \u0394AUC of 0.009. Conclusions: Arterial waveform morphology did not improve prediction of postoperative AKI beyond the hypotension burden; overall, these data exclude an incremental gain larger than approximately 0.02\u20130.03 AUC units.<\/jats:p>","DOI":"10.3390\/jcm15176871","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:25:56Z","timestamp":1788542756000},"page":"6871","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative Arterial Waveform Morphology Trajectories and Prediction of Postoperative Acute Kidney Injury: A Latent-Class Analysis of the VitalDB Registry"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2759-9714","authenticated-orcid":false,"given":"Mesher","family":"Ensario\u011flu","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Reanimation, G\u00fclhane Training and Research Hospital, University of Health Sciences, 06010 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2282-0291","authenticated-orcid":false,"given":"Alperen Kutay","family":"Y\u0131ld\u0131r\u0131m","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, G\u00fclhane Training and Research Hospital, University of Health Sciences, 06010 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1038\/s41581-021-00418-2","article-title":"Postoperative acute kidney injury in adult non-cardiac surgery: Joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative","volume":"17","author":"Prowle","year":"2021","journal-title":"Nat. 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