Abstract
BackgroundAbdominal wall tension (AWT) plays an important role in the pathogenesis of abdominal compliance (AC). This study uses a polynomial regression model to analyze the correlation between intra-vesical pressure(IVP) and AWT in critically ill patients and provides new ideas for the diagnosis and treatment of critically ill patients with intra-abdominal hypertension（IAH）.MethodsA retrospective analysis was conducted in critically ill patients who met the inclusion criteria and were admitted to the Department of intensive care unit of Daping Hospital of Army Medical University from March 14, 2019, to May 23, 2020. According to the IVP on the first day of ICU admission and death within 28 days, the patients were divided into the IAH group (IVP ≥12 mmHg), the non-IAH group, the survival group and the nonsurvival group. The demographic and clinical data, prognostic indicators, AWT and IVP on days 1-7 after entering the ICU, IAH risk factors, and 28-day death risk factors were collected.ResultsA total of 100 patients were enrolled, with an average age of 45.59±11.4 years. There were 55 males (55%), 30 patients from departments of internal medicine (30%), 43 patients from surgery departments (43%), and 27 trauma patients (27%). In the IAH group, there were 50 patients (29 males, 58%), with an average age of 45.28±12.27 years; there were 50 patients (26 males, 52%) in the non-IAH group, with an average age of 45.90±10.58 years. The IVP on the 1st day and the average IVP within 7 days of the IAH group was 18.99（17.52，20.77）mmHg and 19.43（16.87，22.25）mmHg, respectively, which was higher than that of the non-IAH group [ 6.14（3.48，8.70）mmHg, 6.66（2.74，9.08）mmHg], p＜0.001. The AWT on the 1st day and the average AWT within 7 days of the IAH group was 2.89±0.32 N/mm and 2.82±0.46 N/mm, respectively, which was higher than that of the non-IAH group [(2.45±0.29)N/mm,(2.43±0.39)N/mm],p＜0.001.The polynomial regression models showed that the average AWT and IVP on the 1st day and within 7 days were AWTday1 = -2.450×10-3IVP2+9.695×10-2 IVP+2.046，r=0.667（p＜0.0001），and AWTmean = -2.293×10-3IVP2+9.273×10-2 IVP+2.081, respectively. The logistic regression analysis showed that AWTday1 of 2.73-2.97 N/mm increased the patient's 28-day mortality risk (OR: 6.834; 95%: 1.105-42.266, p=0.010).ConclusionsThere is a nonlinear correlation between AWT and IVP in critically ill patients, and a high AWT may indicate poor prognosis.
Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients—A Prospective Multicenter Study (IROI Study)
