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Risk factors for increased intra-abdominal pressure in severe acute pancreatitis

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Background: Under-diagnosed and untreated abdominal compartment syndrome (ACS) is a potential contributing factor to the development of early organ failure seen in patients with severe acute pancreatitis (SAP). It is estimated that 40% of SAP patients will develop IAH and about 10% will develop ACS requiring surgical decompression. The true incidence, however, is not known, as few centers measure the IAP. Materials and methods: We analyzed 26 cases of SAP admitted and treated in our department between July 2014 and March 2015. In all cases IAP was monitored as per the instructions of the WSACS every 8 hours. In patients diagnosed with IAH or ACS the risk factors proposed by the WSACS were assessed for frequency. Relations between the development of IAH ACS and the values recorded on the Modified Marshall Scoring system and the SOFA scores were investigated.

Results: The risk factors that proved to have a strong association with the development of IAH ACS were multiple organ failure on SAP diagnosis, obesity, positive fluid balance, and total SOFA score on SAP diagnosis. Discussion: Research in the fields of SAP and ACS is ongoing. Identifying risk factors for the development of ACS in SAP patients can improve the rates of morbidity and mortality, reduce costs and are essential for the better management of these difficult conditions.

Conclusions: The associations found by our analysis can lead to further research in risk factor identification and prevention of ACS. Multiple organ failure, obesity and a positive fluid balance were found to be associated with increased intra-abdominal pressure or abdominal compartment syndrome more often.

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