Marcos-Neira P, Zubia-Olaskoaga F, López-Cuenca S, Bordejé-Laguna L
Department of Intensive Care Germans Trias i Pujol University Hospital Barcelona Spain.
Department of Intensive Care Donostia - San Sebastián University Hospital Guipúzcoa Spain.
BJS Open. 2018 Mar 15;1(6):175-181. doi: 10.1002/bjs5.29. eCollection 2017 Dec.
The aim of this study was to analyse the relationship between intra-abdominal hypertension (IAH) and severity of acute pancreatitis (AP) measured by the revised Atlanta classification (RAC) and determinant-based classification (DBC). Secondary objectives were to assess IAH as a predictor of morbidity and mortality in the ICU.
This prospective international observational study included patients admitted to the ICU with AP and at least one organ failure. Information was collected on demographics, severity scores at admission using RAC and DBC, organ failure, mechanical ventilation, continuous renal replacement therapy (CRRT), surgery and mortality. Maximum intra-abdominal pressure (IAP) during ICU stay was used for analysis.
Some 374 patients were included. The hospital mortality rate was 28·9 per cent. IAP was measured in 301 patients (80·5 per cent), of whom 274 (91·0 per cent) had IAH and 103 (34·2 per cent) acute compartment syndrome. A higher IAH grade was more likely in patients with severe AP (42 per cent for grade I versus 84 per cent for grade IV) and acute critical pancreatitis (9 versus 25 per cent; P = 0·001). Compared with grade I IAH, patients with grade IV had more infected necrosis (16 versus 28 per cent; P = 0·005), need for surgery (27 versus 50 per cent; P = 0·006), mechanical ventilation (53 versus 84 per cent; P = 0·007) and requirement for CRRT (22 versus 66 per cent; P < 0·001). IAH predicted shock (area under receiver operating characteristic (ROC) curve (AUC) 0·79, 95 per cent c.i. 0·73 to 0·84), respiratory failure (AUC 0·82, 0·77 to 0·87), renal failure (AUC 0·93, 0·89 to 0·96) and mortality (AUC 0·89, 0·86 to 0·93).
IAH was associated with severity of AP classified according to both RAC and DBC systems. IAP grade can predict outcome of AP during ICU stay.
本研究旨在分析腹内高压（IAH）与根据修订的亚特兰大分类法（RAC）和基于决定因素的分类法（DBC）所测定的急性胰腺炎（AP）严重程度之间的关系。次要目标是评估IAH作为重症监护病房（ICU）发病率和死亡率预测指标的情况。
这项前瞻性国际观察性研究纳入了入住ICU且患有AP并至少出现一种器官功能衰竭的患者。收集了患者的人口统计学信息、入院时使用RAC和DBC的严重程度评分、器官功能衰竭情况、机械通气、连续性肾脏替代治疗（CRRT）、手术及死亡率等信息。分析时采用ICU住院期间的最高腹内压（IAP）。
共纳入约374例患者。医院死亡率为28.9%。对301例患者（80.5%）进行了IAP测量，其中274例（91.0%）患有IAH，103例（34.2%）患有急性筋膜间室综合征。重症AP患者（I级为42%，IV级为84%）和急性重症胰腺炎患者（分别为9%和25%；P = 0.001）更易出现较高等级的IAH。与I级IAH患者相比，IV级患者有更多感染性坏死（分别为16%和28%；P = 0.005）、需要手术（分别为27%和50%；P = 0.006）、机械通气（分别为53%和84%；P = 0.007）以及需要CRRT（分别为22%和66%；P < 0.001）。IAH可预测休克（受试者工作特征曲线（ROC）下面积（AUC）为0.79，95%置信区间为0.73至0.84）、呼吸衰竭（AUC为0.82，0.77至0.87）、肾衰竭（AUC为0.93，0.89至0.96）和死亡率（AUC为0.89，0.86至0.93）。
IAH与根据RAC和DBC系统分类的AP严重程度相关。IAP分级可预测ICU住院期间AP的预后。
