Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study)

Annika Reintam Blaser, Adrian Regli, Bart De Keulenaer, Edward J Kimball, Liis Starkopf, Wendy A Davis, Patrick Greiffenstein, Joel Starkopf, Incidence, Risk Factors, and Outcomes of Intra-Abdominal (IROI) Study Investigators, Annamaria Palermo, Kadri Tamme, Liivi Maddison, Triin Jakobson, Mikhail Kirov, Alexey Smetkin, Yana Ilyina, Andrey Litvin, Anastasiya Kazlova, Aliaksandr Filatov, Francisco Pracca, Gustavo Sosa, Maicol Dos Santos, Ioana Grigoras, Irina Ristescu, Adina Blejusca, Zsolt Bodnar, Edit Tidrenczel, Gina Oliveira, Ana Albuquerque, Manuela Fernandes, Ülle Kirsimägi, Carlos A Ordoñez, Ramiro Manzano-Nunez, Bruno M Pereira, Margaret M Moore, Wojciech Dabrowski, Annika Reintam Blaser, Adrian Regli, Bart De Keulenaer, Edward J Kimball, Liis Starkopf, Wendy A Davis, Patrick Greiffenstein, Joel Starkopf, Incidence, Risk Factors, and Outcomes of Intra-Abdominal (IROI) Study Investigators, Annamaria Palermo, Kadri Tamme, Liivi Maddison, Triin Jakobson, Mikhail Kirov, Alexey Smetkin, Yana Ilyina, Andrey Litvin, Anastasiya Kazlova, Aliaksandr Filatov, Francisco Pracca, Gustavo Sosa, Maicol Dos Santos, Ioana Grigoras, Irina Ristescu, Adina Blejusca, Zsolt Bodnar, Edit Tidrenczel, Gina Oliveira, Ana Albuquerque, Manuela Fernandes, Ülle Kirsimägi, Carlos A Ordoñez, Ramiro Manzano-Nunez, Bruno M Pereira, Margaret M Moore, Wojciech Dabrowski

Abstract

Objectives: To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population.

Design: Prospective observational study.

Setting: Fifteen ICUs worldwide.

Patients: Consecutive adult ICU patients with a bladder catheter.

Interventions: None.

Measurements and main results: Four hundred ninety-one patients were included. Intra-abdominal pressure was measured a minimum of every 8 hours. Subjects with a mean intra-abdominal pressure equal to or greater than 12 mm Hg were defined as having intra-abdominal hypertension. Intra-abdominal hypertension was present in 34.0% of the patients on the day of ICU admission (159/467) and in 48.9% of the patients (240/491) during the observation period. The severity of intra-abdominal hypertension was as follows: grade I, 47.5%; grade II, 36.6%; grade III, 11.7%; and grade IV, 4.2%. The severity of intra-abdominal hypertension during the first 2 weeks of the ICU stay was identified as an independent predictor of 28- and 90-day mortality, whereas the presence of intra-abdominal hypertension on the day of ICU admission did not predict mortality. Body mass index, Acute Physiology and Chronic Health Evaluation II score greater than or equal to 18, presence of abdominal distension, absence of bowel sounds, and positive end-expiratory pressure greater than or equal to 7 cm H2O were independently associated with the development of intra-abdominal hypertension at any time during the observation period. In subjects without intra-abdominal hypertension on day 1, body mass index combined with daily positive fluid balance and positive end-expiratory pressure greater than or equal to 7 cm H2O (as documented on the day before intra-abdominal hypertension occurred) were associated with the development of intra-abdominal hypertension during the first week in the ICU.

Conclusions: In our mixed ICU patient cohort, intra-abdominal hypertension occurred in almost half of all subjects and was twice as prevalent in mechanically ventilated patients as in spontaneously breathing patients. Presence and severity of intra-abdominal hypertension during the observation period significantly and independently increased 28- and 90-day mortality. Five admission day variables were independently associated with the presence or development of intra-abdominal hypertension. Positive fluid balance was associated with the development of intra-abdominal hypertension after day 1.

Figures

Figure 1.
Figure 1.
Cumulative prevalence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Data for ACS are presented as number of patients. Data for IAH are presented as number of patients (%) and include ACS patients. Proportion of patients with IAH from the total study cohort (491 patients) is presented.
Figure 2.
Figure 2.
Proportion of patients with different intra-abdominal hypertension (IAH) grades and respective mortality rates. Data for number of patients per IAH grade. Mortality presented in relation to maximum IAH grade at any time during the ICU stay.

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