Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study.
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.
Malbrain
Manu L N G
ML
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
Chiumello
Davide
D
Pelosi
Paolo
P
Bihari
David
D
Innes
Richard
R
Ranieri
V Marco
VM
Del Turco
Monica
M
Wilmer
Alexander
A
Brienza
Nicola
N
Malcangi
Vincenzo
V
Cohen
Jonathan
J
Japiassu
Andre
A
De Keulenaer
Bart L
BL
Daelemans
Ronny
R
Jacquet
Luc
L
Laterre
Pierre-François
PF
Frank
Günther
G
de Souza
Paulo
P
Cesana
Bruno
B
Gattinoni
Luciano
L
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