Clinical Scorecard: Machine Learning Models Utilizing Clinical Parameters to Forecast Intraoperative Hemodynamic Instability in Patients with Hypertensive Pheochromocytomas and Paragangliomas

At a Glance

Key Highlights

• Sustained hypertensive PPGL patients have a threefold higher risk of intraoperative hypertensive emergencies and hypotensive episodes compared to normotensive PPGL patients.
• Catecholamine secretion affects inflammatory responses, coagulation, and erythrocyte morphology, which may predict intraoperative hemodynamic instability.
• Machine learning models can integrate clinical, laboratory, and tumor parameters to predict intraoperative hemodynamic instability risk in hypertensive PPGL patients.

Guideline-Based Recommendations

Diagnosis

• Confirm PPGL diagnosis postoperatively via pathological examination.
• Define sustained hypertension as office SBP ≥140 mmHg and/or DBP ≥90 mmHg on ≥2 visits or 24-h ambulatory SBP/DBP ≥130/80 mmHg.
• Evaluate urinary catecholamines and blood catecholamine metabolites preoperatively using high-performance liquid chromatography methods.

Management

• Preoperative adrenergic alpha-receptor blockade (phenoxybenzamine or terazosin) for at least two weeks before surgery.
• Use laparoscopic or robotic surgical approaches for tumor excision.
• Exclude patients with severe inflammation, infection, or hematologic disorders to reduce confounding risks.

Monitoring & Follow-up

• Monitor intraoperative blood pressure closely to detect hemodynamic instability.
• Assess inflammatory markers (e.g., SII, WLR, NPR, MLR, PLR) and coagulation parameters (APTT, PT, INR, TT) preoperatively.
• Use machine learning predictive models trained on clinical and laboratory data to stratify intraoperative risk.

Risks

• Intraoperative hemodynamic instability may lead to life-threatening complications such as stroke, myocardial infarction, and multiple organ failure.
• Sustained hypertensive PPGL patients have increased risk of hypertensive emergencies and hypotensive episodes during surgery.
• Uncontrolled catecholamine release during anesthesia and surgery can precipitate hemodynamic instability.

Patient & Prescribing Data

Patients with sustained hypertension and unilateral PPGLs undergoing laparoscopic or robotic surgery

Preoperative alpha-adrenergic blockade for at least two weeks is standard to reduce intraoperative hemodynamic instability risk.

Clinical Best Practices

• Exclude patients with active infection, severe inflammation, or hematologic disorders when assessing inflammatory and coagulation markers.
• Collect comprehensive preoperative clinical, laboratory, and tumor data within one week before surgery for accurate risk prediction.
• Utilize machine learning models to integrate multidimensional data for individualized intraoperative hemodynamic instability risk assessment.
• Ensure anesthesia management by an experienced team to maintain blood pressure stability during surgery.

References

• Pheochromocytomas and paragangliomas overview
• Definition of sustained hypertension
• Machine learning in clinical prediction