Jiang Rongjie, Ma Huan, Song Xiaodong, Hu Xiaoguang, Lui Ka Yin, Liang Yujun, Cai Changjie
Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
BMC Gastroenterol. 2025 Mar 28;25(1):204. doi: 10.1186/s12876-025-03772-8.
To investigate the prognostic value of intra-abdominal pressure (IAP) among patients with orthotopic liver transplantation (OLT).
We enrolled adult patients admitted in the Department of Critical Care Medicine of the First Affiliated Hospital of Sun Yat-sen University after undergoing liver transplantation from January 2018 to March 2022.
A total of 382 patients were included, with 73 patients who died within 1 year after admission. Intra-abdominal Hypertension (IAH) was defined as a sustained IAP ≥ 12 mmHg. The incidence of IAH among liver transplant patients was 46.2%. The IAP and sequential organ failure assessment (SOFA) scores were significantly lower in survivors than non-survivors (P < 0.05). Restricted cubic spline (RCS) analysis found that an IAP level above 16 mmHg was significantly associated with an elevated risk of 1-year mortality, and Kaplan-Meier survival curves further validated this finding (log-rank P < 0.001). Multivariate Cox proportional hazards regression model indicated that patients in IAH grade III (HR: 3.16, 95% CI: 1.31-7.62, P = 0.010) and IV (HR: 9.93, 95% CI: 2.84-34.7, P < 0.001) had significantly higher 1-year mortality risks adjusted by SOFA score classifications compared to individuals without IAH. Maximum IAP levels alone and a modified SOFA score incorporating IAH grade demonstrated satisfactory performance in predicting in-hospital mortality among OLT patients (AUC: 0.710, 0.834, respectively).
Elevated intra-abdominal pressure above 16 mmHg was significantly related with worse 1-year survival among OLT patients. Both maximum IAP alone and SOFA score incorporated with IAH components showed strong prognostic values for in-hospital mortality of these individuals.
探讨腹内压（IAP）在原位肝移植（OLT）患者中的预后价值。
我们纳入了2018年1月至2022年3月在中山大学附属第一医院重症医学科接受肝移植后入院的成年患者。
共纳入382例患者，其中73例在入院后1年内死亡。腹内高压（IAH）定义为持续IAP≥12 mmHg。肝移植患者中IAH的发生率为46.2%。存活者的IAP和序贯器官衰竭评估（SOFA）评分显著低于非存活者（P<0.05）。限制立方样条（RCS）分析发现，IAP水平高于16 mmHg与1年死亡率升高显著相关，Kaplan-Meier生存曲线进一步验证了这一发现（对数秩检验P<0.001）。多变量Cox比例风险回归模型表明，与无IAH的个体相比，IAH III级（HR：3.16，95%CI：1.31-7.62，P=0.010）和IV级（HR：9.93，95%CI：2.84-34.7，P<0.001）患者经SOFA评分分类调整后的1年死亡风险显著更高。单独的最大IAP水平和纳入IAH分级的改良SOFA评分在预测OLT患者院内死亡率方面表现出良好的性能（AUC分别为0.710、0.834）。
OLT患者腹内压升高至16 mmHg以上与1年生存率较差显著相关。单独的最大IAP水平和包含IAH成分的SOFA评分对这些个体的院内死亡率均显示出较强的预后价值。
