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Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in the Critically Ill Liver Cirrhotic Patient–Prevalence and Clinical Outcomes. A Multicentric Retrospective Cohort Study in Intensive Care

2021-05Journal article Open access
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dc.contributor.authorPereira, R
dc.contributor.authorBuglevski, M
dc.contributor.authorPerdigoto, R
dc.contributor.authorMarcelino, P
dc.contributor.authorSaliba, F
dc.contributor.authorBlot, S
dc.contributor.authorStarkopf, J
dc.date.accessioned2023-12-22T15:34:23Z
dc.date.available2023-12-22T15:34:23Z
dc.date.issued2021-05
dc.description.abstractBackground: Liver cirrhosis and ascites are risk factors for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); however, data is scarce. We aimed to determine the prevalence of IAH/ACS in a population of critically ill cirrhotic patients with acute medical illness in intensive care and to assess for risk factors and clinical outcomes. Methods: This was a multicentric retrospective cohort study including two general ICUs and pooled data from a multicentric study between January 2009 and October 2019. Results: A total of 9,345 patients were screened, and 95 were included in the analysis. Mean age was 56.7±1.3 years, and 79% were male. Liver cirrhosis etiology included alcohol in 45.3% and alcohol plus hepatitis C virus in 9.5%. Precipitating events included infection in 26% and bleeding in 21% of cases. Mean severity score MELD and SAPS II were 26.2±9.9 and 48.5±15.3, respectively, at ICU admission. The prevalence of IAH and ACS was respectively 82.1% and 23.2% with a mean value of maximum IAP of 16.0±5.7 mmHg and IAH grades: absent 17.9%, I 26.3%, II 33.7%, III 17.9%, and IV 4.2%. Independent risk factors for IAH were alcoholic cirrhosis (p = 0.01), West-Haven score (p = 0.01), and PaO2/FiO2 ratio (p = 0.02); as well as infection (p = 0.048) for ACS. Overall, 28-day mortality was 52.6% associated with higher IAP and ACS, and independent risk factors were MELD (p = 0.001), white blood cell count (p = 0.03), PaO2/FiO2 ratio (p = 0.03), and lactate concentration (p = 0.04) at ICU admission. Conclusions: This study demonstrates a very high prevalence of IAH/ACS in the critically ill cirrhotic patient in intensive care. Increased IAP and ACS were associated with severity of disease and adverse outcomes and independent risk factors for IAH were alcoholic cirrhosis, hepatic encephalopathy and PO2/FiO2 ratio, as well as infection for ACS. Early diagnosis, prevention, and treatment of IAH/ACS might improve outcome in critically ill cirrhotic patients.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationPLoS One . 2021 May 13;16(5):e0251498.pt_PT
dc.identifier.doi10.1371/journal.pone.0251498pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4767
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.subjectHCC UCIpt_PT
dc.subjectHSM MEDpt_PT
dc.subjectHumanspt_PT
dc.subjectAgedpt_PT
dc.subjectMiddle Agedpt_PT
dc.subjectCritical Carept_PT
dc.subjectMalept_PT
dc.subjectFemalept_PT
dc.subjectCritical Illness* / epidemiologypt_PT
dc.subjectIntensive Care Unitspt_PT
dc.subjectIntra-Abdominal Hypertension / complications*pt_PT
dc.subjectIntra-Abdominal Hypertension / epidemiologypt_PT
dc.subjectIntra-Abdominal Hypertension / therapypt_PT
dc.subjectLiver Cirrhosis / complications*pt_PT
dc.subjectLiver Cirrhosis / epidemiologypt_PT
dc.subjectPrevalencept_PT
dc.subjectLiver Cirrhosis / therapypt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectTreatment Outcomept_PT
dc.subjectSeverity of Illness Indexpt_PT
dc.titleIntra-Abdominal Hypertension and Abdominal Compartment Syndrome in the Critically Ill Liver Cirrhotic Patient–Prevalence and Clinical Outcomes. A Multicentric Retrospective Cohort Study in Intensive Carept_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue5pt_PT
oaire.citation.startPagee0251498pt_PT
oaire.citation.titlePlos Onept_PT
oaire.citation.volume16pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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