Relationship between intra-abdominal pressure and severity of acute pancreatitis

Abstract

Objective To study the relationship between intra-abdominal hypertension (IAH) and the severity of acute pancreatitis,and explore the new markers of worsened outcomes of acute pancreatitis.Methods From June 2012 to November 2013,there were 60 patients diagnosed with acute pancreatitis admitted in the general surgery department of Wuhan General Hospital of Guangzhou Military Region.The patients were classified as mild (group A) or severe (group B) acute pancreatitis according to acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score.Intra-abdominal pressure (IAP) was measured every 4 hours since admission immediately.Urine bladder pressure (UBP) was measured to stand for lAP indirectly,the maximum pressure recorded in all readings in the first 5 days was selected as the recorded value of IAP,and then compare the difference of incidence rate between mild and SAP,investigate the correlation between APACHE Ⅱ score and IAP.Other data such as the length of the hospital stay,the development of persistant systemic inflammatory response syndrome (SIRS),muhiorgan failure,pleural effusion,and mortality were collected,and then compare the difference of the incidence of indicators above mentioned between patients with IAH or not,draw the ROC curve of APACHE Ⅱ score and IAP in identifying patients with adverse clinical process.Results The development of IAH was exclusively associated with SAP with an APACHE Ⅱ score ≥8,identifying all patients who were going to develop abdominal compartment syndrome (ACS).The presence of ACS was associated with a significantly increased extent of multiple organ failure,and mortality,the difference of complication incidence between patients with IAH or not is significance.IAP shared a strong significant positive relationship (Pearson r =0.866) with APACHE Ⅱ score among SAP,and which is better than APACHE Ⅱ in predicting SAP with adverse outcomes for the AUC is greater than APACHE Ⅱ score.Conclusion IAH is a reliable marker of severe disease for it shared a strong significant positive relationship with APACHE Ⅱ score and which is better than APACHE Ⅱ in predicting SAP will undergo adverse outcomes. Key words: Acute pancreatitis; Acute physiology and chronic health evaluation Ⅱ score; Intra-abdominal hypertension