| Abstract: AIMS: Acute pancreatitis is one of the etiological factors responsible for abdominal hypertension. Objective : To Assess the usefulness of IAP as marker of severity in acute pancreatitis
MATERIAL AND METHODS: Prospective, correlative study including all patients admitted for acute pancreatitis into our hospital between July 2002 and January 2004.IAP was measured every 12 hours during hospitalisation. Maximum IAP was defined as the highest pressure measurement obtained from a patient since hospitalisation. Results were correlated with the following variables : Ranson criteria, Apache II, C-reactive protein levels, Balthazar criteria, use of vasoactive drugs, total parenteral nutrition, length of hospital stay, surgery, reintervention, number of examinations, septic complications, appearance of intra-abdominal collections, puncture of these collections and/or placement of percutaneous drainage, culture of the fluid collections, appearance of systemic inflammatory response syndrome or multiorgan failure. Student`s t-test, linear regression and receiving operating curves (ROC) were used in the statistical analysis.
RESULTS: A total of 45 patients (22 men) were included. Etiology of pancreatitis was lithiasis in 35 pts. (78%) and alcohol consumption in 8 (18 %). Nineteen patients (42 %) had an Apache score 8 and were considered as severe pancreatitis.IAP levels 12 mmHg were correlated with mild forms of acute pancreatitis (sensitivity 84 %, specificity 69 %), whereas IAP levels ≥ 16 mmHg correlated with severe forms of acute pancreatitis (sensitivity 36,8%, specificity 100 %) . An increase of one IAP unit increased the risk of severe pancreatitis by a factor of 2,23.Correlation was found between maximum IAP and severity of pancreatitis (p = 0,0001) , death (p = 0,03), Apache II score ( p = 0,034), Apache II score at 72 h (p = 0,045), CT severity index (p = 0,0001), Intensive Care Unit stay (p = 0,008) and number of complementary examinations (p = 0,01).No significant correlation between IAP and the Ranson criteria at admission was found. Significant correlation between maximun IAP and increased intraabdominal collections (p = 0,0001), need for puncture (p = 0,0001) and detection of microorganisms on fluid cultures (p = 0,0001)was found.IAP was significantly higher in patients requiring vasoactive drugs (p = 0,0001), total parenteral nutrition (p = 0,0001) or surgery (p = 0,0001) .DISCUSSION:IAP is a useful, inexpensive and easy-to-measure parameter for indicating the evolution of complications of acute pancreatitis, mainly for sepsis, but is not useful as a prognostic factor of clinical progress when determined at the onset of syntoms.
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