Clin Endosc.  2024 Jul;57(4):476-485. 10.5946/ce.2023.198.

Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea

• Choe JW
• Hyun JJ
• Son SJ
• Lee SH

• KMID: 2558104
• DOI: http://doi.org/10.5946/ce.2023.198

Abstract

Background/Aims
Sedation has become a standard practice for patients undergoing gastrointestinal (GI) endoscopy. However, considering the serious cardiopulmonary adverse events associated with sedatives, it is important to identify patients at high risk. Machine learning can generate reasonable prediction for a wide range of medical conditions. This study aimed to evaluate the risk factors associated with sedation during GI endoscopy and develop a predictive model for hypoxia during endoscopy under sedation.
Methods
This prospective observational study enrolled 446 patients who underwent sedative endoscopy at the Korea University Ansan Hospital. Clinical data were used as predictor variables to construct predictive models using the random forest method that is a machine learning algorithm.
Results
Seventy-two of the 446 patients (16.1%) experienced life-threatening hypoxia requiring immediate medical intervention. Patients who developed hypoxia had higher body weight, body mass index (BMI), neck circumference, and Mallampati scores. Propofol alone and higher initial and total dose of propofol were significantly associated with hypoxia during sedative endoscopy. Among these variables, high BMI, neck circumference, and Mallampati score were independent risk factors for hypoxia. The area under the receiver operating characteristic curve for the random forest-based predictive model for hypoxia during sedative endoscopy was 0.82 (95% confidence interval, 0.79–0.86) and displayed a moderate discriminatory power.
Conclusions
High BMI, neck circumference, and Mallampati score were independently associated with hypoxia during sedative endoscopy. We constructed a model with acceptable performance for predicting hypoxia during sedative endoscopy.

Keyword

Drug-related side effects and adverse reactions; Endoscopy; Hypnotics and sedatives; Hypoxia; Risk factors

Figure

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  Fig. 1. An illustration showing the grades of the Mallampati score.

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  Fig. 2. (A) The curvature test for evaluating the prediction performance and determining the importance of predictors for hypoxia during sedative endoscopy. (B) The area under the receiver operating characteristic curve for the random forest-based model for predicting hypoxia during sedative endoscopy. ROC, receiver operating characteristic; AUC, area under the curve; IQR, interquartile range.

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