Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis

Abstract

IntroductionAlthough intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with substantial morbidity and mortality among critically ill adults, it remains unknown if prevention or treatment of these conditions improves patient outcomes. We sought to identify evidence-based risk factors for IAH and ACS in order to guide identification of the source population for future IAH/ACS treatment trials and to stratify patients into risk groups based on prognosis.MethodsWe searched electronic bibliographic databases (MEDLINE, EMBASE, PubMed, and the Cochrane Database from 1950 until January 21, 2013) and reference lists of included articles for observational studies reporting risk factors for IAH or ACS among adult ICU patients. Identified risk factors were summarized using formal narrative synthesis techniques alongside a random effects meta-analysis.ResultsAmong 1,224 citations identified, 14 studies enrolling 2,500 patients were included. The 38 identified risk factors for IAH and 24 for ACS could be clustered into three themes and eight subthemes. Large volume crystalloid resuscitation, the respiratory status of the patient, and shock/hypotension were common risk factors for IAH and ACS that transcended across presenting patient populations. Risk factors with pooled evidence supporting an increased risk for IAH among mixed ICU patients included obesity (four studies; odds ratio (OR) 5.10; 95% confidence interval (CI), 1.92 to 13.58), sepsis (two studies; OR 2.38; 95% CI, 1.34 to 4.23), abdominal surgery (four studies; OR 1.93; 95% CI, 1.30 to 2.85), ileus (two studies; OR 2.05; 95% CI, 1.40 to 2.98), and large volume fluid resuscitation (two studies; OR 2.17; 95% CI, 1.30 to 3.63). Among trauma and surgical patients, large volume crystalloid resuscitation and markers of shock/hypotension and metabolic derangement/organ failure were risk factors for IAH and ACS while increased disease severity scores and elevated creatinine were risk factors for ACS in severe acute pancreatitis patients.ConclusionsAlthough several IAH/ACS risk factors transcend across presenting patient diagnoses, some appear specific to the population under study. As our findings were somewhat limited by included study methodology, the risk factors reported in this study should be considered candidate risk factors until confirmed by a large prospective multi-centre observational study.

Relationship between intra-abdominal hypertension, outcome and the revised Atlanta and determinant-based classifications in acute pancreatitis

“…IAP should be measured in patients with AP as it can predict severity and potentially influence management. The study confirmed the relationships between IAP, organ failure and mortality in the ICU in line with other observations6, 16, 17, 18. Although one study17 found that an IAP of 9 mmHg provided the best predictive value of 30‐day mortality (sensitivity 86 per cent, specificity 87 per cent; AUC ROC 0·91), this very low cut‐off point probably reflects the fact that patients in the present study all had AP and at least one organ failure.…”

“…Initial validation studies11, 12 showed that the two classifications were equally accurate in predicting mortality, whereas other systems used to assist clinicians in the evolution of AP during an ICU stay have low accuracy13, 14. IAH may be useful to predict local pancreatic and systemic complications8, 15, 16, 17, 18.…”

The effect of crystalloid infusion on body water content and intra-abdominal pressure in patients undergoing orthopedic surgery under spinal anesthesia

“…Indeed, a growing data set presents an increase in IAP following inflammatory-related intestine edema. 9,24,25 Surgery-related injury induces the release of proinflam- matory cytokines, such as tumor necrosis factor α (TNFα), vascular endothelial growth factor (VEGF), many interleukins, histamine, and E-selectine, which may disturb vascular permeability, and increase fluid shift into the extravascular space. 26,27 Moreover, surgery-related perioperative stress induces the release of antidiuretic hormone, cortisol and corticotrophins, and stimulates the renin-angiotensin-aldosterone system to increase salt and fluid retention.…”

Biochemical Changes in Experimental Rat Model of Abdominal Compartment Syndrome

“…1 IAP has also been observed during laparoscopic interventions that are widely used nowadays in the diagnosis and treatments of many diseases. 2 Increase in IAP ≥ 20 mmHg leads to progression of abdominal compartment syndrome (ACS) that is associated with organ dysfunction or failure not manifested before the elevation of IAP.…”