CLINICAL TRIAL article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
This article is part of the Research Topic25 Years of 21st Century MedicineView all 29 articles
A nomogram for predicting sedation-related adverse events in elderly patients undergoing painless gastrointestinal endoscopy
Provisionally accepted
- Chengdu Wenjiang District People’s Hospital, Chengdu, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Elderly patients undergoing painless gastrointestinal endoscopy are at increased risk for sedation-related adverse events (SRAEs) because of their greater physiological vulnerability and higher likelihood of comorbidities. Risk stratification before endoscopy may improve perioperative safety and individualize sedation and management. Objective: This study aimed to develop and internally validate a Firth-penalized multivariable logistic regression model and nomogram to predict SRAEs in elderly patients undergoing painless gastrointestinal endoscopy Methods: Prospective data from 520 patients at least 60 years old who underwent painless gastrointestinal endoscopy between April 2023 and June 2024 at our medical center were randomly divided into a training set (n = 364) and validation set (n = 156). SRAEs were defined as intraoperative hypotension or hypoxemia, and independent predictors of SRAEs in the training set were identified through Firth's penalized multivariable logistic regression. A nomogram to predict risk of SRAEs was developed using R software and tested against the validation set. Its performance was assessed in terms of receiver operating characteristic curves, calibration plots, and decision curve analysis. Results: In the training set, hypotension and hypoxemia occurred in 39.0% and 33.5% of patients, respectively, the incidence of SRAEs was 45.6%.The independent predictors were older age, history of snoring, frailty, preexisting hypertension, chronic obstructive pulmonary disease, prolonged fasting before the procedure, and higher initial dose of etomidate-propofol. Conversely, regular physical activity was a protective factor. The nomogram built from the training set discriminated between people in the validation set who experienced SRAEs or not with an area under the curve of 0.92 (95% CI, 0.86– 0.97), it showed good calibration in the Hosmer–Lemeshow test(P =0.63), and decision curve analysis demonstrated clinical utility across a wide range of threshold probabilities(7%–93%). Conclusion: A predictive model based on readily available clinical variables can accurately estimate SRAE risk in elderly patients undergoing painless gastrointestinal endoscopy. The model may be useful for individualizing sedation and patient management.
Keywords: sedation, gastrointestinal endoscopy, elderly patients, Hypotension, hypoxemia
Received: 26 Sep 2025; Accepted: 19 Dec 2025.
Copyright: © 2025 Xu, Yin, Liu, Liu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Qian Liu
Hongyan Zhang
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.