Dataset Information

A nomogram for predicting the risk of intra-abdominal hypertension in critically ill patients based on ultrasound and clinical data.

ABSTRACT:

Background

Intra-abdominal hypertension (IAH) is a common complication in critically ill patients. This study aimed to identify independent risk factors for IAH and generate a nomogram to distinguish IAH from non-IAH in these patients.

Methods

We retrospectively analyzed 89 critically ill patients and divided them into an IAH group [intra-abdominal pressure (IAP) ≥12 mmHg] and a non-IAH group (IAP <12 mmHg) based on the IAP measured from their bladders. Ultrasound and clinical data were also measured. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for IAH. The correlation between IAP and independent risk factors was also assessed.

Results

Of these 89 patients, 45 (51%) were diagnosed with IAH. Univariate analysis showed there were significant differences in the right renal resistance index (RRRI) of the interlobar artery, the right diaphragm thickening rate (RDTR), and lactic acid (Lac) between IAH and non-IAH groups (P<0.001). Multivariate logistic regression analysis revealed that increasing RRRI, RDTR, and Lactic acid (Lac) were independent risk factors for IAH (P=0.001, P=0.001, and P=0.039, respectively). IAP was significantly correlated with RRRI, RDTR, and Lac (r=0.741, r=-0.774, and r=0.396, respectively; P<0.001). The prediction model based on regression analysis results was expressed as follows: predictive score = -17.274 + 31.125 × RRRI - 29.074 × RDTR + 0.621 × Lac. Meanwhile, the IAH nomogram prediction model was established with an area under the receiver operating characteristic (ROC) curve of 0.956 (95% confidence interval: 0.909-1.000). The nomogram showed good calibration for IAH with the Hosmer-Lemeshow test (P=0.864) and was found to be applicable within a wide threshold probability range, especially that higher than 0.40.

Conclusions

The noninvasive nomogram based on ultrasound and clinical data has good diagnostic efficiency and can predict the risk of IAH. This nomogram may provide valuable guidance for clinical interventions to reduce IAH morbidity and mortality in critically ill patients.

SUBMITTER: Chen B

PROVIDER: S-EPMC10585564 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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A nomogram for predicting the risk of intra-abdominal hypertension in critically ill patients based on ultrasound and clinical data.

Chen Baoquan B Yang Shuping S Lyu Guorong G Cheng Xiaomei X Chen Ming M Xu Jinyang J

Quantitative imaging in medicine and surgery 20230920 10

<h4>Background</h4>Intra-abdominal hypertension (IAH) is a common complication in critically ill patients. This study aimed to identify independent risk factors for IAH and generate a nomogram to distinguish IAH from non-IAH in these patients.<h4>Methods</h4>We retrospectively analyzed 89 critically ill patients and divided them into an IAH group [intra-abdominal pressure (IAP) ≥12 mmHg] and a non-IAH group (IAP <12 mmHg) based on the IAP measured from their bladders. Ultrasound and clinical dat ...[more]

PMID: 37869298

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Project description:BackgroundIn critically ill children, detection of intra-abdominal hypertension (IAH > 10 mmHg) and abdominal compartment syndrome (ACS = IAH + organ dysfunction) is paramount and usually monitored through intra-vesical pressures (IVP) as current standard. IVP, however, carries important disadvantages, being time-consuming, discontinuous, with infection risk through observer-dependent manipulation, and ill-defined for catheter sizes. Therefore, we sought to validate air-capsule-based measurement of intra-gastric pressure (ACM-IGP).MethodsWe prospectively compared ACM-IGP with IVP both in vivo and in vitro (water column), according to Abdominal-Compartment-Society validation criteria. We controlled for patient age, admission diagnosis, gastric filling/propulsive medication, respiratory status, sedation levels and transurethral catheters, all influencing intra-abdominal pressure (IAP).ResultsIn tertiary care PICU setting, finally, n = 97 children were enrolled (median age, 1.3 years [range 0 days-17 years], LOS-PICU 8.0 [1-332] days, PRISM-III-Score 13 [0-35]). In n = 2.770 measurements pairs, median IAP was 6.7 [0.9-23.0] mmHg, n = 38 (39%) children suffered from IAH > 10 mmHg, n = 4 from ACS. In vitro against water column, ACM-IGP correlated perfectly (r2 0.99, mean bias - 0.1 ± 0.5 mmHg, limits of agreement (LOA) - 1.1/+ 0.9, percentage error [PE] 12%) as compared with IVP (r2 0.98, bias + 0.7 ± 0.6 mmHg, LOA - 0.5/+ 1.9, PE 15%). With larger IVP catheters at higher pressure levels, IVP underestimated pressures against water column. In vivo, agreement between either technique was strong (r2 0.95, bias 0.3 ± 0.8 mmHg, LOA - 1.3/+ 1.9 mmHg, PE 23%). No impact of predefined control variables on measurement agreement was observed.ConclusionsIn a large PICU population with high IAH prevalence, ACM-IGP agreed favourably with IVP. More widespread usage of ACM-IGP may improve detection rates of ACS in critically ill children. Trial registration WHO-ICTRP-No. DRKS00006556 (German Clinical Trial Register). Registered 12th September 2014, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006556.

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Project description:ObjectiveIn this retrospective analysis, we explored the clinical characteristics and risk factors of secondary infections in patients with severe heatstroke with the aim to gain epidemiological insights and identify risk factors for secondary infections.MethodThe study included 129 patients with severe heatstroke admitted to the General Hospital of the Southern Theater Command of the PLA between January 1, 2011, and December 31, 2021. Patients were divided into an infection group (n = 24) and a non-infection group (n = 105) based on infection occurrence within 48 h of intensive care unit (ICU) admission. Clinical indicators, infection indicators, and clinical outcomes within 24 h of ICU admission were collected and compared between the groups. Independent risk factors for infection in patients with severe heatstroke were analyzed using univariate and multivariate analyses. A nomogram model was constructed, evaluated, and validated.ResultAmong the 129 patients with heatstroke, 24 developed secondary infections. Infections occurred between days 3 and 10 post-ICU admission, primarily affecting the lungs. Multivariate analysis identified vasopressor use, serum creatinine level, and gastrointestinal dysfunction at admission as independent risk factors, while elevated lymphocyte count (odds ratio [OR] = 0.167; 95% confidence interval [CI] 0.049-0.572; P = 0.004) was protective against severe heatstroke. Infected patients required longer durations of mechanical ventilation (OR = 2.764; 95% CI, 1.735-4.405; P = 0.044) and total hospital stay than those in the non-infection group. The nomogram model demonstrated clinical feasibility.ConclusionIncreased lymphocyte count is an independent protective factor against infections in patients with severe heatstroke. Vasopressor use, gastrointestinal dysfunction, and elevated serum creatinine levels are independent risk factors. These indicators can aid clinicians in assessing infection risk in patients with severe heatstroke.

Dataset Information

A nomogram for predicting the risk of intra-abdominal hypertension in critically ill patients based on ultrasound and clinical data.

Background

Methods

Results

Conclusions

Publications

A nomogram for predicting the risk of intra-abdominal hypertension in critically ill patients based on ultrasound and clinical data.

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