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Intra-abdominal Pressure Has a Good Predictive Power for 28-Day Mortality: A Prospective Observational Study
Yujian Liang1, Shaohua Tao2, Bin Gu3
1Department of Pediatric Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Insights
Intra-abdominal pressure (IAP) in critically ill children predicts mortality, with values above 12.13 mmHg indicating higher risk. Normal IAP ranges from 2.0-13.2 mmHg, unaffected by patient demographics.
Area of Science:
- Pediatric Critical Care Medicine
- Physiology
- Clinical Outcomes Research
Background:
- Elevated intra-abdominal pressure (IAP) is linked to organ dysfunction in critically ill children.
- The predictive value of IAP for mortality in this population is not well-established.
- Normal IAP values in pediatric intensive care unit (PICU) patients require further determination.
Purpose of the Study:
- To determine the predictive value of IAP for 28-day mortality in PICU patients.
- To establish normal IAP reference ranges for children in the PICU.
Main Methods:
- Prospective observational study in two tertiary care PICUs.
- IAP measured via bladder pressure every 8 hours for up to 48 hours.
- Binary logistic regression and ROC curves analyzed IAP's predictive value for mortality.
Main Results:
- IAP and lactic acid independently predicted 28-day mortality (HR 1.09 and 3.04, respectively).
- IAP demonstrated good predictive power for mortality (AUC 0.74), with an optimal cutoff of 12.13 mmHg.
- Normal IAP values in children without high-risk factors were 7.57 ± 2.85 mmHg (range 1.98-13.16 mmHg).
Conclusions:
- IAP is a significant predictor of 28-day mortality in PICU children.
- An IAP cutoff of 12.13 mmHg is proposed for identifying increased mortality risk.
- The established IAP reference range (2.0-13.2 mmHg) is independent of patient demographics, suggesting its utility in critical illness scoring.
Abstract:
Objective: Elevated intra-abdominal pressure (IAP) is associated with organ dysfunction in critically ill children. Thus far, the predictive value of IAP for mortality remains unknown. Moreover, only few studies determined normal IAP values in pediatric intensive care unit (PICU) children. This study aimed to determine the predictive value of IAP for mortality and calculate normal IAP values in PICU patients. Methods: This prospective observational study was conducted in two PICUs of two tertiary care university teaching hospitals. Patients admitted to the PICU between December 2013 and November 2015 were included. IAP was determined by bladder pressure measurements performed every 8 h until 48 h or until PICU discharge. All patients (except neonatal patients) aged ≤ 14 years who were admitted to the PICUs and had no history of chemical neuromuscular blockade use, neurogenic bladder, or bladder surgery were enrolled. Binary logistic regression was used to analyze the predictive value of IAP for 28-day mortality. Receiver operating characteristic curves were generated to evaluate the prediction effect of IAP. Results: Overall, 229 patients were enrolled. IAP (hazard ratio 1.09, 95% confidence interval [CI] 1.029-1.161, P = 0.004) and lactic acid (hazard ratio 3.04, 95% CI 1.769-5.21, P < 0.001) were independent predictors of 28-day mortality. Additionally, IAP had good predictive power for 28-day mortality, with an area under the curve of 0.74. The optimal cutoff point was 12.13 mmHg (sensitivity 0.58, specificity 0.80). The Youden index was 0.38.Furthermore, 111 (48.47%) patients without high-risk factors or clinical manifestations of IAH were analyzed to determine normal IAP values, which were 7.57 ± 2.85 mmHg (range, 1.98-13.16 mmHg). There were no significant differences in normal IAP values according to different diseases, sex, age, weight, or body mass index (BMI). Conclusions: IAP has good predictive power for 28-day mortality. The optimal IAP cutoff point is 12.13 mmHg. The IAP reference range is 2.0-13.2 mmHg, which was not associated with factors such as sex, age, weight, and BMI in PICU children. We recommend that IAP be included in critical illness scoring systems in the future. IAP >12.13 mmHg may be more suitable for IAH definition in PICU patients.
