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Intra-abdominal pressure at ICU admission: Evaluation as a predictor of severity and mortality in severe acute pancreatitis

Ratendar Kumar Singh, Parnadi Bhaskar Rao, Arvind Kunar Baronia, Banani Poddar, Afzal Azim, Mohan Gurjar, Neha Singh, Vasudevan Senthilvel, Kamlesh Singh

Abstract


Background and aims. Approximately 20% of acute pancreatitis progresses to a severe form characterised by multiple extrapancreatic organ dysfunction. Elevated intra-abdominal pressure (IAP), a frequent finding in these patients, further adds to the mortality. Currently used prognostication indices have their own set of limitations. We evaluated intra-abdominal pressure at intensive care unit (ICU) admission as a predictor of mortality in severe acute pancreatitis (SAP).

Methods. A retrospective analysis of 50 patients with SAP admitted to the ICU of a tertiary-care Indian institute over a period of 3 years was done. Data relating to demographic profile, cause of pancreatitis, ICU admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, IAP, interventions instituted and mortality were analysed.

Results. Biliary stones (38%) were the most common cause of acute pancreatitis. Survivors differed from non-survivors with respect to organ failure, APACHE II and SOFA scores and IAP on admission. There was a significant correlation between IAP on ICU admission and admission SOFA (r=0.56, p<0.001) and APACHE II (r=0.54, p<0.001) in predicting mortality. Patients with elective admission had a mortality rate of 53% (20/38) compared with 83% (10/12) for those admitted as emergencies. Analysis of receiver operating characteristic curves for detecting mortality revealed an area under the curve of 0.915 (95% confidence interval (CI) 0.83 - 0.99) for IAP, 0.826 (CI 0.71 - 0.93) for SOFA, and 0.831(95% CI 0.71 - 0.94) for APACHE II.

Conclusion. IAP at ICU admission is a useful predictor of severity of illness and mortality in SAP.

Authors' affiliations

Ratendar Kumar Singh, Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India

Parnadi Bhaskar Rao, Department of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences (PIMS), Pondicherry, India

Arvind Kunar Baronia, Department of Critical Care Medicine, SGPGIMS, Lucknow, India

Banani Poddar, Department of Critical Care Medicine, SGPGIMS, Lucknow, India

Afzal Azim, Department of Critical Care Medicine, SGPGIMS, Lucknow, India

Mohan Gurjar, Department of Critical Care Medicine, SGPGIMS, Lucknow, India

Neha Singh, Department of Anaesthesiology and Critical Care, PIMS, Pondicherry, India

Vasudevan Senthilvel, Department of Community Medicine, PIMS, Pondicherry, India

Kamlesh Singh, Clinical Epidemiology, Chhatrapati Sahuji Maharaj Medical University, Lucknow, India

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Keywords

APACHE II score; intra-abdominal pressure; mortality; severe acute pancreatitis; SOFA score; ICU admission

Cite this article

Southern African Journal of Critical Care 2012;28(1):20-25.

Article History

Date submitted: 2012-02-09
Date published: 2012-07-09

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