Intra-abdominal Pressure as a Prognostic Factor in Severe Acute Pancreatitis

Abstract

Abstract Objective:To assess the prognostic value of Intra-abdominal Pressure in severe acute pancreatitis, compare it to APACHE II, to determine when to intervene based on intra abdominal pressure. Materials and Methods:We studied the role of intra-abdominal pressure measurement as a prognostic index and its applicability to determine the timing of intervention in cases of severe acute pancreatitis as a prospective cohort study from 2010- 2012, at Kamineni Hospital, L.B Nagar, Hyderabad. All patients who were admitted with severe acute pancreatitis and consented to take part in the study were enrolled. All patients were evaluated clinically, radiologically, biochemically and by the prognostic indices – APACHE II, Ranson criteria and intra-abdominal pressure measurement. A total of 55 patients were enrolled in this study. Intra-abdominal pressure was measured by intravesical technique using a Foley catheter.Intra-abdominal pressure was measured every 12 hours. Within 24 hours of admission, APACHE II score was obtained. Multivariate analysis was utilised for statistics. Results:Males comprised 73% of study population. Mean age was 41.23± 13.74 years (17- 83 years). Ten patients (18.81%) died. Among the non-survivors, the intra-abdominal pressure (20.1± 3.1073 Vs 8.97± 4.39) and the APACHE II (17.5 ±4.09 Vs3.93 ±4.345),were significantly greater, P value <0.0001. The AUC for intra-abdominal pressureat 24 hours and at 72 hours was >0.7, which is highly significant. The sensitivity for intra-abdominal pressure(>13 mm Hg) at 72 hours as a marker for mortality was 100%. Conclusion:The Intra-abdominal pressure monitoring is rapid, reproducible, inexpensive and minimally invasive, and can be used as a marker of the severity and prognosis of severe acute pancreatitis. Intra-abdominal pressure could potentially be used to guide the timing of intervention. Compared to APACHE II, which is inclusive of multiple parameters, intra-abdominal pressure can serve the same purpose as a single prognostic index. Further, we recommend a large, multicentric studies to conclusively establish the predictive power of intra-abdominal pressure in acute pancreatitis and whether interventions known to reduce intra-abdominal pressure, can alter the ultimate outcome.