Erhöhter intraabdomineller Druck: ein wichtiger Risikofaktor für frühe Organdysfunktionen bei schwerer akuter Pankreatitis

Background: Sustained increase of the intra-abdominal pressure is recently recognized as a potential risk factor of early organ dysfunction in patients with severe acute pancreatitis. Assessment of the possible mutual relevance between increased intra-abdominal pressure and early organ dysfunction is important for optimisation of the treatment strategy in this category of patients. Patients and methods: 71 patients with severe acute pancreatitis were entered in this prospective study. Clinical routine, sequential organ failure assessment score (SOFA), and intra-abdominal pressure were registered, considering 25 cm H 2 O a critical value for the grouping in high-risk (n = 18) and low-risk (n = 53) patients according to whether they experienced the critical level during their treatment course. Results: The age structure and the initial presentation of the organ dysfunction were similar between both groups. Progression of the organ dysfunction was observed in 61% of the high-risk patients, compared to 32% of low-risk patients, p < 0.05. Organ function improved after three to four day treatment only in survivors. Peak intra-abdominal pressure was greater in high-risk patients, p < 0.01, but declined after three to five day treatment period in all survivors, remaining critical in nonsurvivors. 78% of high-risk and 32 % of low-risk patients were operated, p < 0.05. The overall mortality was 8.5%, consisting of 2% mortality in the low-risk group and 28 % mortality in the high-risk group, p < 0.01. Conclusion: Increased intra-abdominal pressure could be an important risk factor of early organ dysfunction in patients with severe acute pancreatitis. Critical increase of the intra-abdominal pressure and persisting organ dysfunction are an indication for reassessment of the treatment strategy.