title: Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study.
abstract: OBJECTIVE
  Intraabdominal hypertension is associated with significant morbidity and mortality in surgical and trauma patients. The aim of this study was to assess, in a mixed population of critically ill patients, whether intraabdominal pressure at admission was an independent predictor for mortality and to evaluate the effects of intraabdominal hypertension on organ functions.
  
  
  METHODS
  Multiple-center, prospective epidemiologic study.
  
  
  METHODS
  Fourteen intensive care units in six countries.
  
  
  METHODS
  A total of 265 consecutive patients admitted for >24 hrs during the 4-wk study period.
  
  
  METHODS
  None.
  
  
  RESULTS
  Intraabdominal pressure was measured twice daily via the bladder. Data recorded on admission were the patient demographics with Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation II score, and type of admission; during intensive care stay, Sepsis-Related Organ Failure Assessment score and intraabdominal pressure were measured daily together with fluid balance. Nonsurvivors had a significantly higher mean intraabdominal pressure on admission than survivors: 11.4 +/- 4.8 vs. 9.5 +/- 4.8 mm Hg. Independent predictors for mortality were age (odds ratio, 1.04; 95% confidence interval, 1.01-1.06; p = .003), Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.1; 95% confidence interval, 1.05-1.15; p < .0001), type of intensive care unit admission (odds ratio, 2.5 medical vs. surgical; 95% confidence interval, 1.24-5.16; p = .01), and the presence of liver dysfunction (odds ratio, 2.5; 95% confidence interval, 1.06-5.8; p = .04). The occurrence of intraabdominal hypertension during the intensive care unit stay was also an independent predictor of mortality (relative risk, 1.85; 95% confidence interval, 1.12-3.06; p = .01). Patients with intraabdominal hypertension at admission had significantly higher Sepsis-Related Organ Failure Assessment scores during the intensive care unit stay than patients without intraabdominal hypertension.
  
  
  CONCLUSIONS
  Intraabdominal hypertension on admission was associated with severe organ dysfunction during the intensive care unit stay. The mean intraabdominal pressure on admission was not an independent risk factor for mortality; however, the occurrence of intraabdominal hypertension during the intensive care unit stay was an independent outcome predictor.
authors.affiliation: Intensive Care Unit Director, Medical Intensive Care Unit, Ziekenhuis Netwerk Antwerpen, Campus Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen 6, Belgium. manu.malbrain@skynet.be
authors.forename: Manu L N G
authors.initials: ML
authors.lastname: Malbrain
authors.forename: Davide
authors.initials: D
authors.lastname: Chiumello
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: David
authors.initials: D
authors.lastname: Bihari
authors.forename: Richard
authors.initials: R
authors.lastname: Innes
authors.forename: V Marco
authors.initials: VM
authors.lastname: Ranieri
authors.forename: Monica
authors.initials: M
authors.lastname: Del Turco
authors.forename: Alexander
authors.initials: A
authors.lastname: Wilmer
authors.forename: Nicola
authors.initials: N
authors.lastname: Brienza
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Malcangi
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohen
authors.forename: Andre
authors.initials: A
authors.lastname: Japiassu
authors.forename: Bart L
authors.initials: BL
authors.lastname: De Keulenaer
authors.forename: Ronny
authors.initials: R
authors.lastname: Daelemans
authors.forename: Luc
authors.initials: L
authors.lastname: Jacquet
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Laterre
authors.forename: Günther
authors.initials: G
authors.lastname: Frank
authors.forename: Paulo
authors.initials: P
authors.lastname: de Souza
authors.forename: Bruno
authors.initials: B
authors.lastname: Cesana
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
mesh_terms: D018806:APACHE; D034841:Abdominal Cavity / Q000503:physiopathology*; D000368:Aged; D003161:Compartment Syndromes / Q000175:diagnosis; D016638:Critical Illness / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis; D011312:Pressure; D011379:Prognosis; D012307:Risk Factors; D014882:Water-Electrolyte Balance