| Abstract: Introduction : Intra-abdominal pressure (IAP) is an independent predictor for adverse outcome in patients with acute renal failure (ARF) (1-2). Recently abdominal perfusion pressure (APP) calculated as the mean arterial pressure minus the intra-abdominal pressure (IAP), was found to be a better resuscitation endpoint than IAP alone (3). Until now no multicentre data is available with regard to the effect of IAP and APP on outcome in patients with ARF. The aim of the present epidemiologic study was to clarify this problem.
Methods : Over a 12 month period patient admitted with or developing ARF during their ICU stay and hospitalised in 2 different ICU’s were studied prospectively. ARF was defined as an increase of serum creatinine above 2mg/dl. Patients were screened for IAH (defined as IAP>12 mmHg, normal 0-5 mmHg) with the standardised intravesical pressure recording method. The IAP was recorded twice daily together with the highest and lowest APP, fluid balance, and SOFA score. There were 78.3% medical and 21.7% surgery patients. The major study endpoint was 28 day mortality. Until now data are collected on 60 patients from 2 centers. Values are mean±SD.
Results :The BMI was 26.5±4.6, M/F ratio 1/1, age 69.3±16.7, APACHE-II score 26.8±9.2, SAPS-II score 50.1±12.5. The renal SHARF-II score was 66.6±22.1 on admission and 75.7±24.2 after 48 hours. SOFA score on day 1 was 9.4±3.5 with 1.7±1.1 organ failures. IAP on day 1 was 11.6±5.4 mmHg, while APP was 54.7±17.6. Maximal IAP after 48 hours (IAPmax) was 13.5±6.3. Mean ICU stay was 13.5±15.4 days. Intra-abdominal hypertension above 12 mmHg within 48 hours of study inclusion was present in 63.4% patients. Outcome data on 46 patients showed a 28 day mortality of 63%. Outcome didn’t differ between patients with or without IAH although patients non-survivors had a significantly higher IAP and lower APP by day 3 (Figure 1). There was a trend towards a more positive daily fluid balance and cumulative net fluid balance in non-survivors.
Conclusions : The preliminary results of an ongoing prospective multicenter clinical trial show that the incidence of IAH is extremely high in patients with ARF. Mortality is high and underestimated by classic severity scores. The SHARF-II score better predicts outcome in these patients. The persistence of IAH and low APP by day 3 was able to discriminate between survivors and non-survivors. Close monitoring of IAP and APP therefore seems warranted in patients with ARF.
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