Comparison of Intra-abdominal pressure monitoring vs APACHE-II and Ranson’s scoring in predicting the outcome of Acute Pancreatitis

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Introduction: Intra-abdominal pressure is important risk factor for predicting mortality and morbidity in the early phase of acute pancreatitis. World Society on the abdominal compartment syndrome defines Intra-abdominal hypertension as a sustained increase in pressure above 12 mm of Hg and abdominal compartment syndrome is a sustained increase in intra-abdominal pressure above 20 mm of Hg with new onset organ failure. However, even values of lower than 15 mm of Hg may cause organ dysfunction. Material and Methods: Intra-abdominal pressure was indirectly determined by measuring urinary bladder pressure with a 16 gauge Foley’s catheter in situ. The bladder was drained completely and the tubing of the collecting bag was clamped and then the catheter will be connected to a saline manometer. Intra-abdominal pressure was measured on day 1st, 3rd, 7th and 14th after controlling the severe pain by analgesics. Result: In our study 50 patient of acute pancreatitis was taken. Patient was categorized in low risk and high risk group according to Ranson’s, APACHE and IAP criteria. It was observed that there is a positive correlation between IAP with APACHE and Ranson’s score, positive predictive value for assessment of mortality (4%), Ranson’s (4%), APACHE scoring (4%). It was observed that as the grade of Ranson’s and APACHE increases in patients of acute pancreatitis, IAP also increases. Similarly for morbidity most of the local complication occurs in moderate to severe grade of IAP 1st day (>15 mm), severe grade of APACHE score (>13) and severe grade of Ranson’s score (>3). Common systemic complication were gastrointestinal (98%), circulatory (52%), respiratory (68%), metabolic (56%), renal (24%), MODS (10%), ARDS (8%), DIC (4%). Most of the systemic complication occurs in moderate to severe grade of IAP 1st day (>15), severe grade of APACHE score (>8) and severe grade of Ranson’s score (>3). Conclusion: IAP measurement is cheap, easy, bedside, minimally invasive prognostic modality, cheaper alternative to Ranson’s and APACHE scoring. Early IAP monitoring can be very useful in assessment of mild to severe acute pancreatitis, hospital stay, determines local and systemic complication.