Darweesh Mohammad, El-Kurdi Bara, Mahfouz Ratib, Haddaden Metri, Mansour Mahmoud, Obeidat Adham E, Ghanem Fares, Young Mark F
East Tennessee State University Quillen College of Medicine, 178 Maple Ave, Mountain Home, Johnson City, TN, 37684, USA.
The University of Texas at San Antonio, MC 8320, 8300 Floyd Curl Dr 4TH FLOOR-4A, San Antonio, TX, 78229, USA.
Dig Dis Sci. 2025 Mar;70(3):1233-1245. doi: 10.1007/s10620-024-08749-3. Epub 2024 Dec 20.
Acute pancreatitis is one of the leading causes of mortality and morbidity. Most acute pancreatitis scoring systems have no pathophysiologic basis when evaluating severity. Such a limitation led to an interest in measuring intra-abdominal pressure (IAP) as a method to predict outcomes in patients with acute pancreatitis.
Investigate the predictive impact of intra-abdominal hypertension (IAH) on mortality and clinical outcomes in a patient hospitalized with severe acute pancreatitis.
We conducted a systematic search of the PubMed, Embase, and Cochrane databases from inception through November 2021 for studies evaluating the effect of IAH on acute pancreatitis. Relevant data were extracted and analyzed using STATA 17 software. A random-effects model was used for all variables. Publication bias was assessed using Egger's test.
Fourteen studies investigating 1197 patients were included. Mortality, multiorgan dysfunction syndrome, pancreatic necrosis, renal, respiratory, and cardiovascular failure were more likely in the IAH group. However, infected necrosis and surgical intervention were not statistically significant between the two groups. After excluding abdominal compartment syndrome patients, mortality and respiratory failure were the only outcomes, which remained statistically significant.
Patients admitted to the hospital with severe acute pancreatitis have higher odds for mortality, multiorgan dysfunction syndrome, renal, respiratory, and cardiovascular failure if they developed IAH. IAH remained a strong predictor of mortality and respiratory failure even in the absence of abdominal compartment syndrome. Therefore, the development of IAH is a strong predictor of mortality and poor clinical outcome in such a population.
急性胰腺炎是导致死亡和发病的主要原因之一。大多数急性胰腺炎评分系统在评估严重程度时没有病理生理学依据。这种局限性引发了人们对测量腹内压（IAP）作为预测急性胰腺炎患者预后方法的兴趣。
研究腹内高压（IAH）对重症急性胰腺炎住院患者死亡率和临床结局的预测影响。
我们对PubMed、Embase和Cochrane数据库进行了系统检索，从数据库建立至2021年11月，以查找评估IAH对急性胰腺炎影响的研究。使用STATA 17软件提取并分析相关数据。对所有变量采用随机效应模型。使用Egger检验评估发表偏倚。
纳入了14项研究，共1197例患者。IAH组的死亡率、多器官功能障碍综合征、胰腺坏死、肾、呼吸和心血管衰竭的发生率更高。然而，两组之间感染性坏死和手术干预在统计学上无显著差异。排除腹腔间隔室综合征患者后，死亡率和呼吸衰竭是仅有的仍具有统计学显著差异的结局。
重症急性胰腺炎住院患者若发生IAH，则死亡、多器官功能障碍综合征、肾、呼吸和心血管衰竭的几率更高。即使在没有腹腔间隔室综合征的情况下，IAH仍然是死亡率和呼吸衰竭的有力预测指标。因此，IAH的发生是这类人群死亡率和不良临床结局的有力预测指标。
