Clinical Prediction Score for Post-Intubation Hypotension Among Pa-tients with Suspected Sepsis: A Retrospective Cohort Study
Archives of Academic Emergency Medicine,
Vol. 14 No. 1 (2026),
1 Mehr 2025
,
Page e59
https://doi.org/10.22037/aaem.v14i1.3158
Abstract
Introduction: Post-intubation hypotension (PIH) is a clinically important complication of emergency airway management and may be particularly relevant in patients with sepsis because of their limited hemodynamic reserve. This study aimed to develop and internally validate a clinical prediction model for PIH and derive a simplified bedside score. Methods: We conducted a retrospective cohort study of patients aged ≥15 years with suspected or confirmed sepsis who underwent emergency endotracheal intubation in the emergency department of Ramathibodi Hospital between January 2013 and December 2023. PIH was defined as systolic blood pressure <90 mmHg within 30 minutes after intubation. Candidate predictors were evaluated using logistic regression, and model reduction was guided by clinical relevance and model fit. Internal validation was performed using 1,000 bootstrap resamples. A simplified score was derived from the final model by categorizing continuous predictors and assigning points based on their regression coefficients. Results: Among 372 patients, 66 (17.7%) developed PIH. The final model included age, pre-intubation systolic blood pressure (SBP), non-rapid sequence intubation (non-RSI), and etomidate use. Increasing age (adjusted odds ratio [aOR]: 1.043 per year; 95% CI: 1.017–1.070) and non-RSI (aOR: 2.50; 95% CI: 1.40–4.47) were associated with higher odds of PIH, whereas higher pre-intubation SBP (aOR: 0.986 per mmHg; 95% CI: 0.977–0.996) and etomidate use (aOR: 0.46; 95% CI: 0.25–0.84) were associated with lower odds. The model had an apparent area under the receiver operating characteristic curve (AUROC) of 0.727 and an optimism-corrected AUROC of 0.711. The simplified 4-point score assigned one point each for age ≥75 years, SBP <110 mmHg, non-RSI, and absence of etomidate use. PIH incidence increased from 7.7% at a score of 0 to 63.6% at a score of 4. The simplified score had an AUROC of 0.708 (bootstrap 95% CI: 0.641–0.775), which was not statistically different from that of the continuous model (p=0.241). Conclusion: A four-variable peri-intubation model showed moderate discrimination for PIH in patients with suspected sepsis undergoing emergency intubation. The simplified bedside score may help identify patients who require closer hemodynamic monitoring and preparation during airway management. External validation is needed before routine clinical use.
- Intubation
- Intratracheal
- Sepsis
- Hypotension
- Emergency Service
- Hospital
- Risk Assessment
How to Cite
References
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