Should intra-abdominal pressure measurement be a routine for all pancreatitis patients?

Acute pancreatitis remains a disease with an unpredictable clinical course, and significant associated morbidity and mortality. Recently, the elevated intraabdominal pressure (IAP) after onset of acute pancreatitis has gained growing attention, because it is increasingly recognized as an important risk factor for mortality in the early phase of the disease. However, It is still not clear whether early intra-abdominal pressure measurement should be a routine for all acute pancreatitis patients and which patients would benefit most from the IAP monitoring.

A research team led by Dr. Zilvinas Dambrauskas from Lithuania addressed this question. Their study will be published on February 14, 2009 in the World Journal of Gastroenterology.

In their study, Patients (n = 44) with AP recruited in this study were divided into two groups (ACS and non-ACS) according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems: Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score, and Multiorgan Dysfunction Score (MODS). The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using Receiver Operating Characteristic (ROC) curve analysis.

They found that the incidence of ACS in our study population was 19.35%. IAP at admission of ACS group was 22.0 (18.5-25.0) mmHg and 9.25 (3.0-12.4) mmHg in non-ACS group (P < 0.01). Univariate statistical analysis revealed that patients in ACS group had significantly higher multifactorial clinical scores (APACHE Ⅱ, Glasgow-Imrie and MODS) on admission and higher maximal scores during hospitalization (P < 0.01). ROC curve analysis revealed that APACHE Ⅱ, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cutoff values are similar to those used for stratification of patients with severe acute pancreatitis (SAP).

They concluded that IAH and ACS are rare findings in patients with mild AP and they recommend measuring the IAP in cases when patients present with SAP (APACHE Ⅱ > 7; MODS > 2 or Glasgow-Imrie score > 3).

Reference: Dambrauskas Z, Parseliunas A, Gulbinas A, Pundzius J, Barauskas G. Early recognition of abdominal compartment syndrome in patients with acute pancreatitis. World J Gastroenterol 2009; 15(6): 717-721 http://www.wjgnet.com/1007-9327/15/717.asp

Correspondence to: Dr. Zilvinas Dambrauskas, Department of Surgery, Kaunas University of Medicine Hospital, Eiveniu Str. 2, 50009 Kaunas, Lithuania. zilvinas.dambrauskas@gmail.com

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