Pharmacokinetic State Space Models for Unbiased Prediction of Haemodynamic Collapse

An Intraoperative Hypotension (IOH) event is a frequent complication during administration of general anaesthesia with serious downstream consequences, yet clinical management remains reactive and not predictive. Existing predictive models, however, ignore drug infusion history as a valuable signal for prediction despite its direct pharmacological relevance. Our model achieves an Area Under the Receiver Operating Characteristic curve (AUROC) of 0.7360 and an Area Under the Precision-Recall Curve (AUPRC) of 0.1794, representing a 2.73-fold lift over the random guessing AUPRC baseline (0.0657), with the removal of propofol and remifentanil effect-site concentrations resulting in a 13.9% AUPRC drop compared to the full model. This is consistent with the hypothesis that pharmacokinetic trajectories encode impending haemodynamic changes before they manifest in the Mean Arterial Pressure (MAP). Additionally, this paper shows that training without lead-gap filtering degraded AUROC by 16.7%, empirically confirming that unfiltered models learn to detect ongoing hypotension rather than predict future events. Finally, a Mamba-based architecture achieves the aforementioned high prediction performance while maintaining a constant memory footprint across a range of sequence lengths, unlike the quadratic VRAM overhead typical of vanilla Transformers, making it the more practical choice for continuous intraoperative deployment.