Skip to main content
SpringerLink
Log in

Intra-abdominal Pressure and Abdominal Perfusion Pressure: Which is a Better Marker of Severity in Patients with Severe Acute Pancreatitis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Intra-abdominal hypertension is common in patients with severe acute pancreatitis. The aim of this study was to assess the clinical relevance of intra-abdominal pressure and abdominal perfusion pressure in the first 72 h after admission during severe acute pancreatitis.

Methods

From January 2009 to February 2011, 50 patients admitted for severe acute pancreatitis were included in this prospective, observational study. The intra-abdominal pressure and abdominal perfusion pressure level were repeatedly measured every 12 h during the first 72 h. The maximum and the mean values of intra-abdominal pressure and the minimum and mean values of abdominal perfusion pressure were used for analysis.

Results

Both the maximum and mean levels of intra-abdominal pressure were significantly different between patients with or without kinds of clinical variables. But for abdominal perfusion pressure, difference could only be detected in terms of need of vasoactive drugs. Besides that, different from abdominal perfusion pressure, intra-abdominal pressure is associated with high incidence rates of MODS and secondary infection.

Conclusion

Compared with abdominal perfusion pressure, intra-abdominal pressure is much more valuable as an early marker of the evolution and complications of severe acute pancreatitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, Carter R, Di Magno E, Banks PA, Whitcomb DC, Dervenis C, Ulrich CD, Satake K, Ghaneh P, Hartwig W, Werner J, McEntee G, Neoptolemos JP, Buchler MW. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology 2002;2 (6): 565–573.

    Article  PubMed  Google Scholar 

  2. McKay CJ, Evans S, Sinclair M, Carter CR, Imrie CW. High early mortality rate from acute pancreatitis in Scotland, 1984–1995. Br J Surg 1999;86 (10): 1302–1305.

    Article  PubMed  CAS  Google Scholar 

  3. Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 2000;232 (5): 619–626.

    Article  PubMed  CAS  Google Scholar 

  4. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 2006; 32 (11): 1722–1732.

    Article  PubMed  Google Scholar 

  5. De Waele JJ, Hoste E, Blot SI, Decruyenaere J, Colardyn F. Intra-abdominal hypertension in patients with severe acute pancreatitis. Crit Care 2005;9(4): R452-457.

    Article  PubMed  Google Scholar 

  6. Pupelis G, Austrums E, Snippe K, Berzins M. Clinical significance of increased intraabdominal pressure in severe acute pancreatitis. Acta Chir Belg 2002;102(2): 71–74.

    PubMed  CAS  Google Scholar 

  7. Pupelis G, Plaudis H, Snippe K, Rudakovska M. Increased intra-abdominal pressure: is it of any consequence in severe acute pancreatitis? HPB (Oxford) 2006;8(3): 227–232.

    CAS  Google Scholar 

  8. Chen H, Li F, Sun JB, Jia JG. Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage. World J Gastroenterol 2008;14(22): 3541–3548.

    Article  PubMed  Google Scholar 

  9. Malbrain ML, Deeren D, De Potter TJ. Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care 2005;11(2): 156–171.

    Article  PubMed  Google Scholar 

  10. Bradley EL, 3 rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993;128(5): 586–590.

    PubMed  Google Scholar 

  11. Beger HG, Rau BM. Severe acute pancreatitis: Clinical course and management. World J Gastroenterol 2007;13(38): 5043–5051.

    PubMed  Google Scholar 

  12. Jones AE, Trzeciak S, Kline JA. The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med 2009;37(5): 1649–1654.

    Article  PubMed  Google Scholar 

  13. Keskinen P, Leppaniemi A, Pettila V, Piilonen A, Kemppainen E, Hynninen M. Intra-abdominal pressure in severe acute pancreatitis. World J Emerg Surg 2007;2: 2.

    Article  PubMed  Google Scholar 

  14. Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma 2000;49(4): 621–626; discussion 626–627.

    Article  PubMed  CAS  Google Scholar 

  15. Atila K, Terzi C, Ozkardesler S, Unek T, Guler S, Ergor G, Bora S, Gulay H. What is the role of the abdominal perfusion pressure for subclinical hepatic dysfunction in laparoscopic cholecystectomy? J Laparoendosc Adv Surg Tech A 2009;19(1): 39–44.

    Article  PubMed  Google Scholar 

  16. Rosas JM, Soto SN, Aracil JS, Cladera PR, Borlan RH, Sanchez AV, Ros FB, Posa LG. Intra-abdominal pressure as a marker of severity in acute pancreatitis. Surgery 2007;141(2): 173–178.

    Article  PubMed  Google Scholar 

  17. Al-Bahrani AZ, Abid GH, Holt A, McCloy RF, Benson J, Eddleston J, Ammori BJ. Clinical relevance of intra-abdominal hypertension in patients with severe acute pancreatitis. Pancreas 2008;36(1): 39–43.

    Article  PubMed  Google Scholar 

  18. Beger HG, Rau B, Isenmann R. Natural history of necrotizing pancreatitis. Pancreatology 2003;3(2): 93–101.

    Article  PubMed  Google Scholar 

  19. Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut 2004;53(9): 1340–1344.

    Article  PubMed  CAS  Google Scholar 

  20. Tsui NC, Zhao E, Li Z, Miao B, Cui Y, Shen Y, Qu P. Microbiological findings in secondary infection of severe acute pancreatitis: a retrospective clinical study. Pancreas 2009;38(5): 499–502.

    Article  PubMed  Google Scholar 

  21. Buter A, Imrie CW, Carter CR, Evans S, McKay CJ. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg 2002;89(3): 298–302.

    Article  PubMed  CAS  Google Scholar 

  22. Pitchumoni CS, Patel NM, Shah P. Factors influencing mortality in acute pancreatitis: can we alter them? J Clin Gastroenterol 2005;39(9): 798–814.

    Article  PubMed  CAS  Google Scholar 

  23. Baron TH. Predicting the severity of acute pancreatitis: is it time to concentrate on the hematocrit? Am J Gastroenterol 2001;96(7): 1960–1961.

    Article  PubMed  CAS  Google Scholar 

  24. Radenkovic D, Bajec D, Ivancevic N, Milic N, Bumbasirevic V, Jeremic V, Djukic V, Stefanovic B, Milosevic-Zbutega G, Gregoric P. D-dimer in acute pancreatitis: a new approach for an early assessment of organ failure. Pancreas 2009;38(6): 655–660.

    Article  PubMed  CAS  Google Scholar 

  25. Salomone T, Tosi P, Palareti G, Tomassetti P, Migliori M, Guariento A, Saieva C, Raiti C, Romboli M, Gullo L. Coagulative disorders in human acute pancreatitis: role for the D-dimer. Pancreas 2003;26(2): 111–116.

    Article  PubMed  CAS  Google Scholar 

  26. Wilson C, Heath DI, Imrie CW. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg 1990;77(11): 1260–1264.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported in part by the social development funding of Jiangsu province.

Conflict of Interest

The authors have not disclosed any potential conflicts of interest.

Author information

Authors and Affiliations

  1. Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China

    Lu Ke, Hai-bin Ni, Zhi-hui Tong, Wei-qin Li, Ning Li & Jie-shou Li

  2. Department of SICU, Research Institute of General Surgery, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China

    Wei-qin Li

Authors
  1. Lu Ke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hai-bin Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhi-hui Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei-qin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ning Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jie-shou Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei-qin Li.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ke, L., Ni, Hb., Tong, Zh. et al. Intra-abdominal Pressure and Abdominal Perfusion Pressure: Which is a Better Marker of Severity in Patients with Severe Acute Pancreatitis. J Gastrointest Surg 15, 1426–1432 (2011). https://doi.org/10.1007/s11605-011-1553-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-011-1553-3

Keywords

Search

Navigation