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Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis

Jessalyn K Holodinsky1, Derek J Roberts2*, Chad G Ball3, Annika Reintam Blaser4, Joel Starkopf4, David A Zygun5, Henry Thomas Stelfox6, Manu L Malbrain7, Roman C Jaeschke8 and Andrew W Kirkpatrick9

Author Affiliations

1 Department of Community Health Sciences (Division of Health Services Research), University of Calgary, Intensive Care Unit Administration, Foothills Medical Center, 3134 Hospital Drive Northwest, T2N 5A1, Calgary, AB, Canada

2 Departments of Surgery and Community Health Sciences (Division of Epidemiology), University of Calgary, Intensive Care Unit Administration, Foothills Medical Center, 3134 Hospital Drive Northwest, T2N 5A1, Calgary, AB, Canada

3 Hepatobiliary and Pancreatic Surgery, Trauma and Acute Care Surgery, University of Calgary, Foothills Medical Center, 1403-29 Street NW, T2N 2T9, Calgary, AB, Canada

4 Clinic of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014, Tartu, Estonia

5 Division of Critical Care Medicine, Zone Clinical Department, Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, General Systems ICU, University of Alberta Hospital, 8440 - 112 Street, T6G 2B7, Edmonton, AB, Canada

6 Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6, Calgary, AB, Canada

7 Intensive Care Unit and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen, ZNA, Stuivenberg, Lange Beeldekensstraat, 267, 2060, Antwerpen 6, Belgium

8 Department of Medicine, Department of Clinical Epidemiology and Biostatistics, Critical Care Response Team, St Joseph's Hospital, McMaster University, 50 Charlton Avenue East, L8N 4A6, Hamilton, ON, Canada

9 The Departments of Surgery and Critical Care Medicine and Regional Trauma Services, Foothills Medical Centre, 1403-29 Street NW, T2N 4Z6, Calgary, AB, Canada

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Critical Care 2013, 17:R249  doi:10.1186/cc13075

Published: 21 October 2013

Abstract

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 1,224 citations identified, 14 studies enrolling 2,500 patients were included. The 38 identified risk factors for IAH and 24 for ACS could be clustered into three themes and eight 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 (four studies; odds ratio (OR) 5.10; 95% confidence interval (CI), 1.92 to 13.58), sepsis (two studies; OR 2.38; 95% CI, 1.34 to 4.23), abdominal surgery (four studies; OR 1.93; 95% CI, 1.30 to 2.85), ileus (two studies; OR 2.05; 95% CI, 1.40 to 2.98), and large volume fluid resuscitation (two 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.