Intra-abdominal pressure as a predictor of acute kidney injury in postoperative abdominal surgery.
OBJECTIVE
The purpose of this study was to determine if intra-abdominal pressure (IAP) could predict acute renal injury (AKI) in the postoperative period of abdominal surgeries, and which would be its cutoff value.


METHODS
A prospective observational study was conducted in the period from January 2010 to March 2011 in the Intensive Care Units (ICUs) of the University Hospital of Botucatu Medical School, UNESP. Consecutive patients undergoing abdominal surgery were included in the study. Initial evaluation, at admission in ICU, was performed in order to obtain demographic, clinical surgical and therapeutic data. Evaluation of IAP was obtained by the intravesical method, four times per day, and renal function was evaluated during the patient's stay in the ICU until discharge, death or occurrence of AKI.


RESULTS
A total of 60 patients were evaluated, 16 patients developed intra-abdominal hypertension (IAH), 45 developed an abnormal IAP (>7 mmHg) and 26 developed AKI. The first IAP at the time of admission to the ICU was able to predict the occurrence of AKI (area under the receiver-operating characteristic curve was 0.669; p=0.029) with the best cutoff point (by Youden index method) ≥ 7.68 mmHg, sensitivity of 87%, specificity of 46% at this point. The serial assessment of this parameter did not added prognostic value to initial evaluation.


CONCLUSIONS
IAH was frequent in patients undergoing abdominal surgeries during ICU stay, and it predicted the occurrence of AKI. Serial assessments of IAP did not provided better discriminatory power than initial evaluation.
Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University , UNESP, Botucatu , Brazil .
Ana Carolina dos Santos
AC
Demarchi
Cibele Taís Puato
CT
de Almeida
Daniela
D
Ponce
Meire Cristina Novelli
MC
e Castro
Aline Roberta
AR
Danaga
Fabio Akio
FA
Yamaguti
Danielle
D
Vital
Ana Lúcia
AL
Gut
Ana Lúcia dos Anjos
AL
Ferreira
Larissa
L
Freschi
Juliana
J
Oliveira
Ubirajara Aparecido
UA
Teixeira
José Carlos
JC
Christovan
Juliana Rigoto
JR
Grejo
Luís Cuadrado
LC
Martin
D000005:Abdomen / Q000503:physiopathology* / Q000601:surgery*; D058186:Acute Kidney Injury / Q000150:complications / Q000175:diagnosis*; D003422:Critical Care; D005260:Female; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000150:complications / Q000175:diagnosis; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis*; D011312:Pressure; D011446:Prospective Studies