A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: The wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!)

M. L N G Malbrain, D. Chiumello, B. M. Cesana, A. Reintam Blaser, J. Starkopf, M. Sugrue, P. Pelosi, P. Severgnini, G. Hernandez, N. Brienza, A. W. Kirkpatrick, A. Schachtrupp, J. Kempchen, E. Estenssoro, M. G. Vidal, I. De Laet, B. L. De Keulenaer

Research output: Contribution to journalArticle

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Abstract

Intra-abdominal hypertension (IAH), defined as a pathologically increase in intraabdominal pressure, is commonly found in critically ill patients. While IAH has been associated with several abdominal as well as extra-abdominal conditions, few studies have examined the occurrence of IAH in relation to mortality. The aim of this paper was to evaluate the prognostic role of IAH and its risk factors at admission in critically ill patients across a wide range of settings and countries. An individual patient meta-analysis of all available data and a systematic review of published (in full or as abstract) medical databases and studies between 1996 and June 2012 were performed. The search was limited to "clinical trials" and "randomized controlled trials", "adults", using the terms "intra-abdominal pressure", "intraabdominal hypertension" combined with any of the terms "outcome" and "mortality". All together data on 2707 patients, representing 21 centers from 11 countries was obtained. Data on 1038 patients were not analysed because of the following exclusion criteria: no LAP value on admission (N.=712), absence of information on ICU outcome (N.=195), age 95 years (N.=131). Data from 1669 individual patients (19 centers from 9 countries) were analyzed in the meta-analysis. Presence of IAH was defined as a sustained increase in LAP equal to or above 12 mmHg. At admission the mean overall LAP was 9.9±5.0 mmHg, with 463 patients (27.7%) presenting IAH with a mean LAP of 16.3±3.4 mmHg. The only independent predictors for IAH were SOFA score and fluid balance on the day of admission. Five hundred thirteen patients (30.8%) died in intensive care. The independent predictors for intensive care mortality were IAH, SAPS II score, SOFA score and admission category. This systematic review and individual patient data meta-analysis shows that IAH is frequently present in critically ill patients and it is an independent predictor for mortality.

Original languageEnglish
Pages (from-to)293-306
Number of pages14
JournalMinerva Anestesiologica
Volume80
Issue number3
Publication statusPublished - 2014

Fingerprint

Intra-Abdominal Hypertension
Critical Illness
Meta-Analysis
Epidemiology
Hypertension
Mortality
Critical Care
Pressure
Water-Electrolyte Balance
Randomized Controlled Trials
Clinical Trials

Keywords

  • Critical care
  • Intra-abdominal hypertension
  • Meta-analysis.
  • Mortality
  • Multiple organ failure
  • Risk factors

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients : The wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!). / Malbrain, M. L N G; Chiumello, D.; Cesana, B. M.; Blaser, A. Reintam; Starkopf, J.; Sugrue, M.; Pelosi, P.; Severgnini, P.; Hernandez, G.; Brienza, N.; Kirkpatrick, A. W.; Schachtrupp, A.; Kempchen, J.; Estenssoro, E.; Vidal, M. G.; De Laet, I.; De Keulenaer, B. L.

In: Minerva Anestesiologica, Vol. 80, No. 3, 2014, p. 293-306.

Research output: Contribution to journalArticle

Malbrain, MLNG, Chiumello, D, Cesana, BM, Blaser, AR, Starkopf, J, Sugrue, M, Pelosi, P, Severgnini, P, Hernandez, G, Brienza, N, Kirkpatrick, AW, Schachtrupp, A, Kempchen, J, Estenssoro, E, Vidal, MG, De Laet, I & De Keulenaer, BL 2014, 'A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: The wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!)', Minerva Anestesiologica, vol. 80, no. 3, pp. 293-306.
Malbrain, M. L N G ; Chiumello, D. ; Cesana, B. M. ; Blaser, A. Reintam ; Starkopf, J. ; Sugrue, M. ; Pelosi, P. ; Severgnini, P. ; Hernandez, G. ; Brienza, N. ; Kirkpatrick, A. W. ; Schachtrupp, A. ; Kempchen, J. ; Estenssoro, E. ; Vidal, M. G. ; De Laet, I. ; De Keulenaer, B. L. / A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients : The wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!). In: Minerva Anestesiologica. 2014 ; Vol. 80, No. 3. pp. 293-306.
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