Background
Methods
Patients and setting
IAP measurement
Patient management
IAH definitions
Collected data
Outcome measures
Statistical analysis
Results
Prevalence and incidence of IAH and characteristics of the patients according to IAH
All patients | IAPa < 12 mmHg | IAPa ≥ 12 mmHg |
p value | APPa ≥ 60 mmHg | APPa < 60 mmHg |
p value | |
---|---|---|---|---|---|---|---|
N
= 61
|
N
= 11
|
N
= 50
|
N
= 18
|
N
= 43
| |||
Age in years, mean ± SD | 59.8 ± 12.2 | 63.6 ± 7.4 | 59.0 ± 13.0 | 0.26 | 59.0 ± 14.2 | 60.2 ± 11.5 | 0.74 |
Male sex, N (%) | 36 (59.0) | 7 (63.7) | 29 (58.0) | 1.00 | 7 (38.9) | 18 (41.9) | 0.83 |
Body mass index (Kg/m2), mean ± SD | 26.8 ± 5.9 | 26.5 ± 6.3 | 26.9 ± 5.9 | 0.87 | 26.3 ± 6.5 | 27.0 ± 5.8 | 0.70 |
Etiology of liver cirrhosis, N (%) | |||||||
Hepatitis C | 30 (49.2) | 8 (73.0) | 22 (44.0) | 7 (39.0) | 23 (53.0) | ||
Hepatitis B | 17 (27.9) | 2 (18.0) | 15 (30.0) | 0.27 | 6 (33.0) | 11 (26.0) | 0.56 |
Others | 14 (23.0) | 1 (9.0) | 13 (26.0) | 5 (28.0) | 9 (21.0) | ||
Child-Pugh score, mean ± SD | 11.6 ± 1.6 | 11.2 ± 1.4 | 11.6 ± 1.6 | 0.39 | 11.2 ± 1.9 | 11.7 ± 1.4 | 0.29 |
APACHE II score, mean ± SD | 30.1 ± 7.5 | 23.9 ± 7.7 | 31.5 ± 6.7 | 0.002 | 29.9 ± 7.8 | 30.2 ± 7.4 | 0.91 |
SOFA score, mean ± SD | 14.9 ± 3.7 | 12.5 ± 4.5 | 15.4 ± 3.3 | 0.02 | 13.9 ± 3.7 | 15.3 ± 3.7 | 0.1 |
SOFA renal sub-score | 2.2 ± 1.4 | 2.0 ± 1.7 | 2.3 ± 1.3 | 0.52 | 1.7 ± 1.4 | 2.5 ± 1.3 | 0.06 |
SBP, N (%) | 19 (31.1) | 7 (63.6) | 12 (24.0) | 0.03 | 5 (27.8) | 14 (32.6) | 0.71 |
Encephalopathy, N (%) | 42 (68.9) | 4 (36.4) | 38 (76.0) | 0.03 | 11 (61.1) | 31 (72.1) | 0.28 |
Ascites, N (%) | 58 (95.1) | 11 (100) | 47 (94.0) | 0.05 | 16 (88.9) | 42 (97.7) | 0.26 |
Mechanically ventilated, N (%) | 51 (83.6) | 6 (54.5) | 45 (90.0) | 0.01 | 16 (88.9) | 35 (81.4) | 0.71 |
PaO2/FiO2 ratio (mmHg), mean ± SD | 252 ± 141 | 261 ± 129 | 250 ± 144 | 0.83 | 194 ± 117 | 277 ± 144 | 0.04 |
Norepinephrine dose at inclusion (μg/kg/min), mean ± SD | 0.35 ± 0.35 | 0.20 ± 0.29 | 0.39 ± 0.35 | 0.11 | 0.26 ± 0.34 | 0.39 ± 0.35 | 0.21 |
Creatinineb (μmol/l), mean ± SD | 289 ± 165 | 299 ± 176 | 286 ± 165 | 0.81 | 239 ± 147 | 309 ± 170 | 0.13 |
INR, mean ± SD | 2.8 ± 1.4 | 2.6 ± 1.5 | 2.8 ± 1.4 | 0.71 | 2.4 ± 0.7 | 2.9 ± 1.6 | 0.08 |
Bilirubinb (μmol/l), mean ± SD | 340.3 ± 284.3 | 146.0 ± 193.5 | 383.1 ± 284.6 | 0.01 | 313.3 ± 305.2 | 351.7 ± 278.1 | 0.63 |
Ammoniab (μmol/l), mean ± SD | 110.2 ± 101.1 | 74.7 ± 41.1 | 118.0 ± 108.8 | 0.03 | 111.6 ± 167.2 | 109.6 ± 57.4 | 0.96 |
Albumin (g/l), mean ± SD | 32.5 ± 7.1 | 33.8 ± 8.1 | 32.2 ± 6.9 | 0.50 | 31.5 ± 5.4 | 32.9 ± 7.7 | 0.48 |
Hemoglobin (g/dl), mean ± SD | 8.6 ± 1.6 | 9.4 ± 1.6 | 8.4 ± 1.6 | 0.27 | 8.3 ± 1.5 | 8.7 ± 1.6 | 0.42 |
Lactate levelb (mmol/l), mean ± SD | 4.4 ± 4.3 | 3.7 ± 4.6 | 4.5 ± 4.2 | 0.59 | 2.9 ± 2.2 | 5.0 ± 4.8 | 0.02 |
Fluid intake in day 1 (ml), mean ± SD | 4,356 ± 2,574 | 3,993 ± 1,877 | 4,436 ± 2,712 | 0.61 | 4,015 ± 2,486 | 4,499 ± 3,336 | 0.51 |
Fluid balance in day 1 (ml), mean ± SD | 3,177 ± 2,919 | 1,544 ± 2,980 | 3,537 ± 4,335 | 0.04 | 2,368 ± 2,913 | 3,516 ± 2,887 | 0.16 |
MAP day 1 (mmHg), mean ± SD | 70.7 ± 7.2 | 58.8 ± 5.8 | 59.4 ± 8.1 | 0.83 | 63.3 ± 7.1 | 57.6 ± 7.3 | 0.007 |
CVP day 1 (mmHg), mean ± SD | 15.5 ± 6.2 | 12.3 ± 4.0 | 16.2 ± 6.4 | 0.054 | 14.1 ± 6.5 | 16.1 ± 6.1 | 0.28 |
IAP day 1 (mmHg), mean ± SD | 15.3 ± 4.7 | 9.0 ± 2.2 | 16.7 ± 3.9 | < 0.0001 | 12.8 ± 3.8 | 16.3 ± 4.7 | 0.008 |
APP day 1 (mmHg), mean ± SD | 55.5 ± 7.7 | 59.4 ± 6.2 | 54.6 ± 7.8 | 0.06 | 64.7 ± 5.4 | 51.6 ± 4.7 | < 0.0001 |
Randomization, N (%) | |||||||
Hydrocortisone | 32 (52.5) | 4 (36.4) | 28 (56.0) | 0.24 | 14 (77.8) | 18 (41.9) | 0.01 |
Placebo | 29 (47.5) | 7 (63.6) | 22 (44.0) | 4 (22.2) | 25 (58.1) |
Hemodynamic endpoints
Relationship between IAH and outcomes
IAPa < 12 mmHg | IAPa 1 ≥ 12 mmHg |
p value | APPa ≥ 60 mmHg | APPa < 60 mmHg |
p value | |
---|---|---|---|---|---|---|
N
= 11
|
N
= 50
|
N
= 18
|
N
= 43
| |||
ICU mortality, N (%) | 3 (27.3) | 37 (74.0) | 0.005 | 9 (50) | 31 (72.1) | 0.10 |
Hospital mortality, N (%) | 8 (72.7) | 46 (92.0) | 0.10 | 15 (83.3) | 39 (90.7) | 0.41 |
Duration of MV in days, mean ± SD | 4.8 ± 7.5 | 8.2 ± 6.7 | 0.14 | 9.6 ± 7.1 | 8.9 ± 6.4 | 0.70 |
Ventilator-free days, mean ± SD | 15.3 ± 11.4 | 4.7 ± 7.2 | 0.01 | 7.4 ± 8.7 | 6.3 ± 9.2 | 0.65 |
Vasopressor-free days, mean ± SD | 10.5 ± 8.4 | 4.6 ± 7.1 | 0.02 | 8.4 ± 8.6 | 4.5 ± 7.1 | 0.07 |
ICU LOS (days), mean ± SD | 11.1 ± 8.0 | 9.8 ± 6.0 | 0.56 | 11.0 ± 6.7 | 9.6 ± 6.2 | 0.45 |
Hospital LOS (days), mean ± SD | 31.1 ± 16.8 | 21.1 ± 14.6 | 0.05 | 23.6 ± 10.3 | 22.7 ± 17.1 | 0.81 |
Requirement for RRT, N (%) | 5 (45.5) | 39 (78) | 0.06 | 11 (61.1) | 33 (76.7) | 0.21 |
RRT-free days, mean ± SD | 10.8 ± 12.7 | 5.0 ± 7.5 | 0.17 | 7.4 ± 8.9 | 5.5 ± 8.8 | 0.44 |
IAP and APP as predictors of outcomes
Variable | Intra-abdominal hypertension | Variable | Abdominal hypoperfusion | ||
---|---|---|---|---|---|
Odds ratio
|
95% Confidence interval
|
Odds ratio
|
95% Confidence interval
| ||
ICU mortality | |||||
Intra-abdominal hypertension | 12.20 | 1.92 to 77.31 | Abdominal hypoperfusion | 2.86 | 0.74 to 11.11 |
Age | 1.02 | 0.97 to 1.08 | Age | 0.98 | 0.92 to 1.04 |
INR | 3.60 | 1.29 to 10.06 | INR | 2.67 | 1.02 to 7.00 |
APACHE II score | 1.14 | 1.02 to 1.26 | |||
Hospital mortality | |||||
Intra-abdominal hypertension | 6.83 | 0.86 to 54.12 | Abdominal hypoperfusion | 2.44 | 0.38 to 6.67 |
Age | 1.07 | 0.99 to 1.17 | Age | 1.05 | 0.97 to 1.14 |
INR | 6.2 | 1.07 to 38.5 | INR | 6.36 | 0.92 to 44.22 |
APACHE II score | 1.11 | 0.98 to 1.26 | |||
Renal replacement therapy | |||||
Intra-abdominal hypertension | 6.78 | 1.29 to 35.70 | Abdominal hypoperfusion | 2.78 | 0.68 to 11.11 |
Age | 0.92 | 0.92 to 1.04 | Age | 0.96 | 0.90 to 1.02 |
INR | 2.06 | 0.98 to 4.32 | APACHE | 1.14 | 1.04 to 1.25 |
Child-Pugh score | 0.51 | 0.30 to 0.90 | Child-Pugh score | 0.63 | 0.40 to 0.98 |
Creatinine | 1.00 | 1.00 to 1.01 |