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Original Article
 
Intra-abdominal hypertension and abdominal compartment syndrome in critical medical patients: Incidence, prognosis and association with renal dysfunction
Mohamad Mostafa Habli1, Sirine Omar Ahmad2, Sabine Youssef Karam3, Houssam Nassib Rabah4, Najat Issa Joubran-Fares3
1Nephrology fellow-faculty of medicine, Saint George hospital university medical center, University of Balamand.
2Resident internal medicine-faculty of medicine, Lebanese University.
3Assistant professor of clinical medicine-faculty of medicine, University of Balamand.
4Clinical associate at Makassed General Hospital of Beirut.

Article ID: 100003M05MH2016
doi:10.5348/M05-2016-3-OA-1

Address correspondence to:
Mohamad Mostafa Habli
Nephrology fellow-faculty of medicine
Saint George hospital university medical center
University of Balamand Lebanon, Beirut, Achrafieh
Rmeil

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How to cite this article
Habli MM, Ahmad SO, Karam SY, Rabah HN, Joubran-Fares NI. Intra-abdominal hypertension and abdominal compartment syndrome in critical medical patients: Incidence, prognosis and association with renal dysfunction. Edorium J Med 2016;3:1–11.


Abstract
Aims: The objective of this study was to measure the intra-abdominal pressure (IAP) in critically ill medical patients in order to determine the incidence and prognosis of intra-abdominal hypertension (IAH) in patients with two or more risk factors for IAH. The incidence of acute kidney injury (AKI) in high group patients was also recorded and evaluated.
Methods: This is a prospective study that was conducted at Makassed General Hospital in Beirut. Daily screening of categorized risk factors (CRF) for IAH was performed. In patients with risk factors for IAH, intra-abdominal pressure (IAP) was measured daily during ICU stay. IAH was not measured in the low risk group (less than two categorized risk factors). Data included severity scores (APACHE II, APACHE III and SOFA),demographics, incidence and staging of acute kidney injury (AKI), cumulative fluid balance, mechanical ventilation, BMI< 30, length of stay (LOS), and mortality.
Results: Eighty-eight patients admitted to ICU during four-month duration, were screened for two CRF for IAH. Only 66 patients (67.16%) were found to have ≥2 CRF and thus were included in the study. Out of 66 patients, 41 (62.12%) were found to have IAH. Patients with IAH (41 out of total number of patients 66 with CRF) had higher incidence of AKI (24 patients = 58.5%). The study showed that patients with IAH had higher incidence of AKI, higher severity scores APACHE II, APACHE III, SOFA, and higher mortality rate.IAH was found to be independent risk factor for mortality. High SOFA score was also independent risk factor for mortality.
Conclusion: ICU patients are more likely to have more than two categorized risk factors for IAH on admission. Intra-abdominal hypertension was common in critical ill-medical patients who have ≥2 CRF and was associated with high incidence of acute kidney injury, significant mortality and morbidity. Our study highlights the importance of screening and early detection of IAH, as early detection and management may improve outcomes.

Keywords: Abdominal compartment syndrome, Acute kidney injury (AKI), Intra-abdominal hypertension, Intra-abdominal pressure


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Author Contributions:
Mohamad Mostafa Habli – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sirine Omar Ahmad – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Sabine Youssef Karam – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Houssam Nassib Rabah – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Najat Issa Joubran-Fares – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Mohamad Mostafa Habli et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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