Intra-abdominal hypertension does not predict renal recovery or in-hospital mortality in critically ill patients with acute kidney injury.
BACKGROUND
Although emerging evidence suggests that intra-abdominal hypertension (IAH) is a predictor of the development of acute kidney injury (AKI), it remains unclear whether the presence of IAH is a predictor of prognosis in patients with AKI. The purpose of this study was to assess whether the presence of IAH could predict prognosis in critically ill patients with AKI. The prognostic value of urinary biomarkers was also determined.


METHODS
In this prospective observational study, we enrolled 57 patients with established AKI, who were admitted to the intensive care unit between February 2012 and June 2014. IAH was defined as a sustained elevation in intra-abdominal pressure of ≥12 mmHg, in three consecutive measurements performed daily on the first 3 days. Urinary neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid-binding protein, and simplified acute physiology score II score at the time of admission were also examined.


RESULTS
IAH was observed in 78.9% of patients. The in-hospital mortality was 21.1%, and renal recovery during hospitalization was achieved in 40.4% of patients. Although high urinary NGAL [odds ratio (OR), 1.015] and liver-type fatty acid-binding protein (OR, 1.003) were found to be independent predictors of renal recovery, IAH was not. High urinary NGAL (OR, 1.003) and a high simplified acute physiology score II score (OR, 1.102) were independent predictors of in-hospital mortality, while IAH or urinary liver-type fatty acid-binding protein was not.


CONCLUSIONS
Although IAH is prevalent in critically ill patients with AKI, it did not predict AKI prognosis. However, urinary NGAL was found to be a useful predictor of both renal recovery and in-hospital mortality.
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Hyo Jeong
HJ
Chang
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Jihyun
J
Yang
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Sun Chul
SC
Kim
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Myung-Gyu
MG
Kim
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Sang-Kyung
SK
Jo
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Won-Yong
WY
Cho
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Hyoung-Kyu
HK
Kim
Acute kidney injury; Intra-abdominal hypertension; Prognosis