title: Intra-abdominal Hypertension and Postoperative Kidney Dysfunction in Cardiac Surgery Patients.
abstract: OBJECTIVE
  To determine the incidence of intra-abdominal hypertension (IAH) in adult cardiac surgery patients and its association with postoperative kidney dysfunction.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Single tertiary-care university hospital.
  
  
  METHODS
  Forty-two adult patients having cardiac surgery with cardiopulmonary bypass.
  
  
  METHODS
  Intra-abdominal pressure (IAP) was measured preoperatively, immediately after surgery, and at the following time points after surgery: 3 hours, 6 hours, 12 hours, and 24 hours. Urine neutrophil gelatinase-associated lipocalin (NGAL) levels were measured as a marker of kidney dysfunction at the following time points: prior to surgery, immediately after surgery, 4 to 6 hours after surgery, and 16-to-18 hours after surgery.
  
  
  RESULTS
  Two hundred fifty-two IAPs were measured, and 90 (35.7%) showed IAH. Thirty-five of 42 patients (83.3%) had IAH at 1 time point or more. Peak urine NGAL levels were lower in patients with normal IAP (mean difference = -130.6 ng/mL [95% CI = -211.2 to -50.1], p = 0.002). There was no difference in postoperative kidney dysfunction by risk, injury, failure, loss of kidney function, and end-stage kidney disease (RIFLE) criteria in patients with normal IAP (mean difference = -31.4% [95% CI = -48.0 to 6.3], p = 0.09). IAH was 100% sensitive for predicting postoperative kidney dysfunction by RIFLE criteria, but had poor specificity (54.8%).
  
  
  CONCLUSIONS
  IAH occurs frequently during the perioperative period in cardiac surgery patients and may be associated with postoperative kidney dysfunction.
authors: Department of *Anesthesiology. Electronic address: mmazzeffi@anes.umm.edu.
authors: Michael A
authors: MA
authors: Mazzeffi
authors: School of Medicine.
authors: Patrick
authors: P
authors: Stafford
authors: Department of *Anesthesiology.
authors: Karin
authors: K
authors: Wallace
authors: Department of *Anesthesiology.
authors: Wendy
authors: W
authors: Bernstein
authors: Department of *Anesthesiology.
authors: Seema
authors: S
authors: Deshpande
authors: Department of *Anesthesiology.
authors: Patrick
authors: P
authors: Odonkor
authors: Department of *Anesthesiology.
authors: Ashanpreet
authors: A
authors: Grewal
authors: Department of *Anesthesiology.
authors: Erik
authors: E
authors: Strauss
authors: Department of *Anesthesiology.
authors: Latoya
authors: L
authors: Stubbs
authors: Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD.
authors: James
authors: J
authors: Gammie
authors: Department of *Anesthesiology.
authors: Peter
authors: P
authors: Rock
mesh_terms: D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D059325:Intra-Abdominal Hypertension / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies
keywords: NGAL; acute kidney injury; cardiac surgery; complications; intra-abdominal hypertension; postoperative kidney dysfunction