Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Nephrology and Renal Replacement Therapy division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Medicine (Baltimore). 2023 Jan 27;102(4):e32807. doi: 10.1097/MD.0000000000032807.
High intra-abdominal pressure (IAP) is associated with acute kidney injury (AKI). However, the relationship between intra-abdominal hypertension (IAH) and AKI in medical septic patients is still inconclusive. This prospective cohort study enrolled patients admitted in the Medical Intensive Care Unit from April 2020 to February 2021. Demographic, therapeutic, and laboratory data were obtained upon admission. The evaluation of IAP was performed via the intra-vesical method during the first and second 24 hours of admission. Kidney function was evaluated on the first 3 days and at least on the 7th day of enrollment. Among 79 patients, 30 (38%) developed IAH, while 50 (63.3%) developed AKI within 7 days. On the first day, the mean IAP was 15.4 (interquartile range [IQR], 4) and 7.0 (IQR, 3.7) mm Hg in the IAH and non-IAH groups, respectively. A total of 52 patients (65.8%) developed the primary outcome (i.e., a composite outcome including AKI, treatment with kidney replacement therapy, or death). On Cox proportional-hazards model between IAH and outcomes, after adjustment for multiple covariates, IAH was associated with a composite outcome (hazard ratio [HR], 6.5; 95% confidence interval [CI], 2.3-18.6; P < .005) and the development of AKI (HR, 6.5; 95% CI, 2.3-18.8; P < .005). IAH was associated with a composite outcome of AKI, treatment with kidney replacement therapy, or death in medical septic patients. thaiclinicaltrial.org, Identifier: TCTR20200531001, Registered May 24, 2020.
腹腔内高压（IAP）与急性肾损伤（AKI）有关。然而，在医学感染性休克患者中，腹腔内高压（IAH）与 AKI 之间的关系仍不确定。这项前瞻性队列研究纳入了 2020 年 4 月至 2021 年 2 月期间入住重症监护病房的患者。入院时采集了人口统计学、治疗和实验室数据。通过入院后第 1 天和第 2 天的膀胱内方法评估 IAP。入院第 1 天至第 3 天和至少第 7 天评估肾功能。在 79 例患者中，30 例（38%）发生 IAH，50 例（63.3%）在 7 天内发生 AKI。第 1 天，IAH 组和非 IAH 组的平均 IAP 分别为 15.4（四分位距 [IQR]，4）和 7.0（IQR，3.7）mmHg。共有 52 例患者（65.8%）发生了主要结局（即包括 AKI、肾脏替代治疗或死亡的复合结局）。在 IAH 与结局之间的 Cox 比例风险模型中，在校正多个协变量后，IAH 与复合结局（风险比 [HR]，6.5；95%置信区间 [CI]，2.3-18.6；P<.005）和 AKI 的发生（HR，6.5；95%CI，2.3-18.8；P<.005）相关。IAH 与医学感染性休克患者的 AKI、肾脏替代治疗或死亡的复合结局相关。thaiclinicaltrial.org，标识符：TCTR20200531001，注册于 2020 年 5 月 24 日。
