Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis.
Crit Care. 2013 Oct 21;17(5):R249
Authors: Holodinsky JK, Roberts DJ, Ball CG, Reintam Blaser A, Starkopf J, Zygun DA, Stelfox HT, Malbrain ML, Jaeschke RC, Kirkpatrick AW
INTRODUCTION: Although intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with substantial morbidity and mortality among critically ill adults, it remains unknown if prevention or treatment of these conditions improves patient outcomes. We sought to identify evidence-based risk factors for IAH and ACS in order to guide identification of the source population for future IAH/ACS treatment trials and to stratify patients into risk groups based on prognosis.
METHODS: We searched electronic bibliographic databases (MEDLINE, EMBASE, PubMed, and the Cochrane Database from 1950 until January 21, 2013) and reference lists of included articles for observational studies reporting risk factors for IAH or ACS among adult ICU patients. Identified risk factors were summarized using formal narrative synthesis techniques alongside a random effects meta-analysis.
RESULTS: Among 1224 citations identified, 14 studies enrolling 2500 patients were included. The 38 identified risk factors for IAH and 24 for ACS could be clustered into 3 themes and 8 subthemes. Large volume crystalloid resuscitation, the respiratory status of the patient, and shock/hypotension were common risk factors for IAH and ACS that transcended across presenting patient populations. Risk factors with pooled evidence supporting an increased risk for IAH among mixed ICU patients included obesity [4 studies; odds ratio (OR) 5.10; 95% confidence interval (CI), 1.92 to 13.58], sepsis (2 studies; OR 2.38; 95% CI, 1.34 to 4.23), abdominal surgery (4 studies; OR 1.93; 95% CI, 1.30 to 2.85), ileus (2 studies; OR 2.05; 95% CI, 1.40 to 2.98), and large volume fluid resuscitation (2 studies; OR 2.17; 95% CI, 1.30 to 3.63). Among trauma and surgical patients, large volume crystalloid resuscitation and markers of shock/hypotension and metabolic derangement/organ failure were risk factors for IAH and ACS while increased disease severity scores and elevated creatinine were risk factors for ACS in severe acute pancreatitis patients.
CONCLUSIONS: Although several IAH/ACS risk factors transcend across presenting patient diagnoses, some appear specific to the population under study. As our findings were somewhat limited by included study methodology, the risk factors reported in this study should be considered candidate risk factors until confirmed by a large prospective multi-centre observational study.
PMID: 24144138 [PubMed - as supplied by publisher]