Background: Intra-abdominal hypertension (IAH) is relatively frequent in critical patients. According to the most recent consensus of the World Society of Abdominal Compartment Society (WSACS), there are no predictive factors for IAH diagnosis. Risk factors are the only motivators to date for early IAH diagnosis. Abdominal compartment syndrome (ACS) is defined as sustained intra-abdominal pressure (IAP) maintained above 20 mm Hg (> 3 kPa), with or without abdominal perfusion pressure below 60 mm Hg (< 8 kPa), associated with a new organ dysfunction. Sepsis is a recognized cause of secondary ACS, but to date there is no correlation with admission SOFA (sequential organ failure assessment) score and ACS onset incidence. The objective of the present study is to determine the profile of extra-abdominal septic shock patients with IAH/ACS admitted to the intensive care unit (ICU) and correlating with admission SOFA score. Better understanding of this population may bring to light clinical predictive factors for IAH/ACS early diagnosis.Methods: In this observational study IAH/ACS incidence was correlated with SOFA score calculated at ICU admission. The study enrolled all critically ill patients more than 18 years old admitted to the Medical Intensive Care Unit (MICU) of a university teaching hospital between April and October 2016, who had been diagnosed with extraabdominal septic shock, according to the Surviving Sepsis Campaign and SEPSIS-3.Results: Twenty-five patients were evaluated during 10 hospitalization days. The average age was 51.13 ± 16.52 years, and 64% of the patients were male. Most patients (76%) had pneumonia. On admission, the SOFA score was 6.54 ± 2.71. Mortality rate in the population studied was 52%. The incidence of IAH was 43.5%, while the incidence of ACS in the IAH population was 28%. SOFA admission score in patients with the diagnosis of ACS was of 8.42 ± 1.27. In this study SOFA score higher than 7 is correlated with IAH, with an accuracy of 68.8% (P < 0.03).
Conclusions:The incidence of ACS in patients with extra-abdominal septic shock admitted to a university teaching hospital MICU was higher than those found in the literature. Higher admission and consecutive SOFA score of more than 7 was associated with higher ACS incidence and higher mortality rate.
Abdominal compartment syndrome (ACS) is defined as a sustained intra-abdominal pressure > 20 mm Hg (> 3 kPa), with or without an abdominal perfusion pressure < 60 mm Hg (< 8 kPa), that is associated with new organ dysfunction or failure [1]. It leads to decreased organ perfusion, tissue ischemia, organ failure and death if not identified and adequately treated [2].Although the effects of elevated intra-abdominal pressure have been known since the late 19 th century [3], it was not until the early 1980s that the term ACS was first used by Kron et al. to describe the pathophysiology of intra-abdominal hypertension (IAH) secondary to aortic aneurysm surgery [4,5].
Microalbuminuria tests should be routinely used as a screening and monitoring tool for the assessment of subsequent cardiovascular morbidity and mortality among hypertensive patients.
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