title: Inverted U-Shaped Relationship between Central Venous Pressure and Intra-Abdominal Pressure in the Early Phase of Severe Acute Pancreatitis: A Retrospective Study.
abstract: OBJECTIVE
  Many studies have indicated that intra-abdominal pressure (IAP) is positively correlated with central venous pressure (CVP) in severe cases. However, although elevated IAP is common in patients with severe acute pancreatitis (SAP), its relationship with CVP remains unclear. Our study aimed to investigate the association of IAP with CVP in early-phase SAP patients.
  
  
  METHODS
  In total, 116 SAP patients were included in this retrospective study. On the first day of hospitalization, blood samples were collected for biochemical examination and cytokine concentration monitoring. Additionally, a urinary catheter and right subclavian vein catheter were inserted for IAP and CVP measurement, respectively. Other routine clinical data were also recorded.
  
  
  RESULTS
  Within 24 hours after hospitalization, CVP fluctuated and increased with increasing IAP up to 15.7 mmHg (P = 0.054) but decreased with increasing IAP when the IAP was > 15.7 mmHg (P < 0.001). After adjusting for abdominal perfusion pressure (APP) and mean arterial pressure (MAP), a similar distribution was observed. An inverted U-shaped trend between IAP and CVP was also present in the groups classified according to the patient's sex, local complications, ascites, and serum amylase levels.
  
  
  CONCLUSIONS
  CVP and IAP have an inverted U-shaped relationship, with a peak at an IAP of 15.7 mmHg in the early phase of SAP. After this peak, CVP decreases as IAP increases. These results have crucial implications for clinical fluid resuscitation in SAP patients. In particular, because one CVP value might be correlated with different IAP values in patients with the same CVP, the volume of fluid needed might be different.
authors.affiliation: Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China; Organ Transplant Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, People's Republic of China; School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People's Republic of China.
authors.forename: Chong
authors.initials: C
authors.lastname: Yang
authors.affiliation: Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Key Laboratory of Geriatrics of Health Ministry, Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
authors.forename: Xinglin
authors.initials: X
authors.lastname: Chen
authors.affiliation: Surgical Oncology-Abdominal Department, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Liu
authors.affiliation: Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
authors.forename: Shanmiao
authors.initials: S
authors.lastname: Gou
authors.affiliation: Microarray Core Facility, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America.
authors.forename: Changzhong
authors.initials: C
authors.lastname: Chen
authors.affiliation: Surgical Oncology-Abdominal Department, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Surgical Oncology-Abdominal Department, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
authors.forename: Xin
authors.initials: X
authors.lastname: Jin
authors.affiliation: Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: He
authors.affiliation: Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
authors.forename: Liming
authors.initials: L
authors.lastname: Dong
authors.affiliation: Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
authors.forename: Yushun
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Center for Applied English Studies, the University of Hong Kong, Hong Kong, People's Republic of China.
authors.forename: Na
authors.initials: N
authors.lastname: Luo
authors.affiliation: Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
authors.forename: Heshui
authors.initials: H
authors.lastname: Wu
authors.affiliation: Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
authors.forename: Chunyou
authors.initials: C
authors.lastname: Wang
mesh_terms: D000005:Abdomen / Q000503:physiopathology*; D000208:Acute Disease; D002496:Central Venous Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000503:physiopathology*; D012189:Retrospective Studies