Early recognition of abdominal compartment syndrome in patients with acute pancreatitis.
OBJECTIVE
To assess the value of widely used clinical scores in the early identification of acute pancreatitis (AP) patients who are likely to suffer from intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS).


METHODS
Patients (n = 44) with AP recruited in this study were divided into two groups (ACS and non-ACS) according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems: Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and Multiorgan Dysfunction Score (MODS). The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic (ROC) curve analysis.


RESULTS
The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 (18.5-25.0) mmHg and 9.25 (3.0-12.4) mmHg in the non-ACS group (P < 0.01). Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores (APACHE II, Glasgow-Imrie and MODS) on admission and higher maximal scores during hospitalization (P < 0.01). ROC curve analysis revealed that APACHE II, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cut-off values are similar to those used for stratification of patients with severe acute pancreatitis (SAP).


CONCLUSIONS
IAH and ACS are rare findings in patients with mild AP. Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP (APACHE II > 7; MODS > 2 or Glasgow-Imrie score > 3).
Dambrauskas
Zilvinas
Z
Department of Surgery, Kaunas University of Medicine Hospital, Eiveniu Str. 2, 50009 Kaunas, Lithuania. zilvinas.dambrauskas@gmail.com
Parseliunas
Audrius
A
Gulbinas
Antanas
A
Pundzius
Juozas
J
Barauskas
Giedrius
G
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D003161:Compartment Syndromes / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010195:Pancreatitis / Q000150:complications* / Q000473:pathology; D011379:Prognosis; D012372:ROC Curve