Role of intra-abdominal pressure in early acute kidney injury: A prospective cohort study in critically Ill obstetric patients

Abstract

Aims:This prospective cohort study evaluated intra-abdominal pressure (IAP) and its role in causing acute kidney injury (AKI) in critically ill obstetric patients and utility of urinary neutrophil gelatinase-associated lipocalin (NGAL) to predict AKI.Methods:A total of 50 eligible obstetric patients admitted to our Intensive Care Unit were enrolled and daily IAP measured using indwelling Foley catheter. Early AKI was diagnosed as per the KDIGO criteria and urine assessed for NGAL using ELISA.Results:AKI was seen in 54% and intra-abdominal hypertension (IAH) in 21% patients. In patients with and without AKI, there was statistically similar IAP on day 1 (P = 0.542) and day 2 (P = 0.907) as well as incidence of IAH (19% vs. 23%) (P = 0.766). Area under receiver operating characteristic curve (AUC) for IAP to predict early AKI was 0.499 (95% confidence interval [CI]: 0.325–0.673) (P = 0.992). Urinary NGAL concentration was significantly greater in patients with early AKI compared to those without (P = 0.006); AUC for urinary NGAL to detect early AKI was 0.734 (95% CI: 0.583–0.884) (P = 0.006) and optimal cutoff was 53.7 ng/ml.Conclusions:IAH and AKI are common in critically ill obstetric patients. While IAP does not correlate with early AKI, NGAL is useful to predict AKI.

Intra-abdominal hypertension and increased acute kidney injury risk: a systematic review and meta-analysis

“…A systematic review and meta-analysis showed that invasive MV is associated with a three-fold increase in the likelihood of developing AKI, and various tidal volume and positive end-expiratory pressure settings do not modify this risk. 21 Of the six articles included in this study, four articles found no link between MV and AKI, 7 , 14 , 17 and two articles provided no data regarding MV causing AKI. 1 , 19 Only one study indicated a link between MV and AKI.…”

“… 1 However, one study reported that IAP did not correlate with early AKI in critically ill obstetric patients. 14 Therefore, we conducted a meta-analysis and determined the following: (1) IAH was associated with a higher prevalence of AKI; (2) the pooled OR demonstrated a 2.57-fold increased risk of AKI; and (3) our meta-analysis included both burn and non-burn patients, patients who underwent cardiac surgery and those who underwent non-cardiac surgery, 1 , 7 , 18 , 19 patients whose average age was ≥60 years and those whose average age was <60 years, and patients whose BMI was ≥24 kg/m 2 and those whose BMI was <24 kg/m 2 . Nevertheless, there was no heterogeneity among the included studies.…”

“… 11 – 13 However, another study reported that IAH did not predict the risk of AKI. 14 Moreover, other events in critically ill patients may worsen renal perfusion, such as severe infection.…”