The influence of duration of intra-abdominal hypertension on the prognosis of critically ill patients
10.3760/cma.j.issn.1671-0282.2022.04.021
- VernacularTitle:腹腔高压持续时间对危重症患者预后的影响
- Author:
Jianshe SHI
1
;
Jialong ZHENG
;
Jiahai CHEN
;
Yeqing AI
;
Huifang LIU
;
Bingquan GUO
;
Zhiqiang PAN
;
Qiulian CHEN
;
Mingzhi CHEN
;
Yong YE
;
Rongkai LIN
;
Chenghua ZHANG
;
Yijie CHEN
Author Information
1. 联勤保障部队第九一〇医院外科ICU，泉州 362000
- Keywords:
Duration of intra-abdominal hypertention;
Critically ill;
Mortality;
Prognosis;
Risk factors;
Spearman rank correlation;
Logistic regression analysis;
ROC cu
- From:
Chinese Journal of Emergency Medicine
2022;31(4):544-550
- CountryChina
- Language:Chinese
-
Abstract:
Background:In the clinical setting, the effect of intra-abdominal hypertension on the human body is dependent on time, but its role is not yet clear.Objective:To investigate the effect of the duration of intra-abdominal hypertension (IAH) on the prognosis of critically ill patients.Methods:This prospective cohort study enrolled 256 IAH patients who were admitted to the Surgical ICU of 10 Grade A hospitals in Fujian Province from January 2018 to December 2020. The duration of IAH (DIAH) was obtained after monitoring IAP, and ICU length of stay, duration of mechanical ventilation, duration of continuous renal replacement therapy (CRRT) and average daily energy intake from enteral nutrition during ICU stay were observed and recorded. The correlation was analyzed by Spearman rank correlation. The patients were divided into the survival group and the death group according to their survival state at 60 days after enrollment. Thereafter, clinical characteristics between the two groups were compared. Multivariable logistic regression was used to study and validate the relationship between DIAH and 60-day mortality. The receiver operating characteristics (ROC) curve was established to evaluate the predictive abilities of DIAH on the mortality risk.Results:In critically ill patients, DIAH was positively correlated with duration of mechanical ventilation ( r=0.679, P<0.001), duration of CRRT ( r=0.541, P<0.001) and ICU length of stay ( r=0.794, P<0.001), respectively. In addition, there was a negative correlation between DIAH and average daily energy intake from enteral nutrition ( r=-0.669, P<0.001). After multivariable adjustment, DIAH was an independent risk factor for 60-day mortality in critically patients with IAH ( OR=1.05, 95% CI: 1.01-1.12; P = 0.012), and exhibited a linearity change trend relationship with mortality risk. The ROC curve analysis of DIAH showed that the area under ROC curve (AUC) was 0.825 (95% CI: 0.763~0.886, P<0.01). When the cut-off value was 16.5 days, the sensitivity was 78.4% and the specificity was 75.4%. Conclusions:DIAH is an important risk factor for prognosis in critically ill patients. Early identification and rapid intervention for the etiology of IAH should be performed to shorten DIAH.
