Abstract

BackgroundIntra-abdominal hypertension (IAH) is frequently present in critically ill patients and is an independent predictor for mortality. Better recognition of clinically important thresholds is necessary. Increased intra-abdominal pressure (IAP) is associated with renal dysfunction, and renal failure is one of the most consistently described organ dysfunctions associated with IAH. Obesity is also associated with kidney injury. The underlying mechanisms are not yet fully understood. Increased IAP may be a link in this association. The aim of this study was firstly to find the range in values of intra-abdominal pressure (IAP) in cardiothoracic surgery patients a secondly to investigate the relationship between central obesity, body mass index (BMI) and IAP and thirdly to investigate the relationship between IAP, inflammation and renal function in this population.MethodsConsecutive adult patients admitted to the cardiothoracic unit of the intensive care unit (ICU) after undergoing elective cardiothoracic surgery were included in this prospective, observational study. C-reactive protein (CRP) as a marker of inflammation and serum creatinine as a marker of renal function were measured pre- and postoperatively. Estimated glomerular filtration rates were calculated pre- and postoperatively. BMI was calculated. Waist circumference (WC), hip circumference (HC) and transvesical IAP were measured once directly after admission to the ICU postoperatively. Waist/hip ratio (WHR) was calculated (WC divided by HC). Three definitions of central obesity were used. Central obesity was defined according to WC, WHR or median WHR.ResultsIn total, 186 patients undergoing cardiothoracic surgery were included. Mean IAP was 9.1 mmHg (SD 4.4). IAP ≥ 12 mmHg was observed in 50 patients (26.9 %). IAP > 20 mmHg was measured in 4 patients (2.2 %). There was a positive correlation between IAP and BMI (r 2 = 0.05, p = 0.003). Correlations between IAP and WC (r 2 = 0.02, p = 0.054) and between IAP and WHR (r 2 = 0.01, p = 0.173) were not significant. There were no correlations between pre- or postoperative CRP and IAP (r 2 = 2.3 × 10−4, p = 0.839 and r 2 = 0.013, p = 0.117, respectively). In obese patients postoperative CRP was significantly higher than in non-obese patients (p = 0.034). There were no correlations between pre-operative serum creatinine and IAP (r 2 = 3.3 × 10−5, p = 0.938) or postoperative serum creatinine and IAP (r 2 = 0.003, p = 0.491).ConclusionsThe range in IAP in patients undergoing cardiothoracic surgery was wide. There was a positive correlation between IAP and BMI. Correlations between IAP and indices for central obesity were not significant. In a multiple regression model BMI was a better predictor of IAP than WHR in this population. There were no correlations between pre- or postoperative CRP and IAP. Furthermore, this study did not find evidence for a relation between IAP and pre- and postoperative serum creatinine.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0195-8) contains supplementary material, which is available to authorized users.

Highlights

  • Intra-abdominal hypertension (IAH) is frequently present in critically ill patients and is an independent predictor for mortality

  • This study shows a wide range in intra-abdominal pressure (IAP) in patients undergoing elective cardiothoracic surgery, between 0 and 26 mmHg

  • Postoperative C-reactive protein (CRP) and postoperative serum creatinine are correlated with body mass index (BMI), Waist circumference (WC) and waist/ hip ratio (WHR)

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Summary

Introduction

Intra-abdominal hypertension (IAH) is frequently present in critically ill patients and is an independent predictor for mortality. The aim of this study was firstly to find the range in values of intra-abdominal pressure (IAP) in cardiothoracic surgery patients a secondly to investigate the relation‐ ship between central obesity, body mass index (BMI) and IAP and thirdly to investigate the relationship between IAP, inflammation and renal function in this population. Better understanding of the risks associated with IAH is necessary, as well as recognizing clinically important thresholds [3]. In order to recognize clinically important thresholds, we need to improve our understanding of the range in intra-abdominal pressure (IAP) values. Baseline levels are higher at approximately 9–14 mmHg in morbidly obese patients [11]. These data were derived from several studies in a limited amount of patients. Epidemiological studies have shown BMI as an index of general obesity, whereas waist circumference (WC) and waist/ hip ratio (WHR) are indices of central obesity [12]

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