INTRA-ABDOMINAL HYPERTENSION AS A RISK FACTOR FOR ACUTE KIDNEY INJURY IN GERIATRIC PATIENTS AFTER EMERGENCY ABDOMINAL SURGERY
DOI:
https://doi.org/10.32782/2411-9164.19.1-6Keywords:
geriatric patients, acute kidney injury, intra-abdominal hypertensionAbstract
Acute kidney injury (AKI) is a common complication of emergency abdominal surgery. Intra-abdominal hypertension is an often underestimated risk factor that leads to impaired blood circulation in the abdominal cavity and AKI. But the values of intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP), which are critical for the development of AKI in elderly patients after urgent abdominal surgery, are still not defined. Objective is to evaluate the relationship between IAP and APP and the development of acute kidney injury in geriatric patients after emergency abdominal surgery. Materials and methods. A prospective single-center study included 66 patients older than 60 years who underwent surgery for peritonitis. Every day in the postoperative period, the presence and stage of AKI was determined according to the KDIGO criteria, IAP and APP were measured. IAP was measured through bladder pressure. APP was defined as the difference between mean arterial pressure and IAP in mm Hg. Statistical processing was performed using the program “STATISTICA for Windows 13” (StatSoftInc., No. JPZ804I382130ARCN10-J). Results. Among the examined patients, 48 developed AKI (73% frequency). The average values of IAP in patients with AKI and without AKI were 10.4 (7.4, 13.3) mm Hg and 6.7 (4.4; 9.6) mm Hg respectively (p<0.0001). APP in patients with AKI, respectively, was significantly lower than in patients without AKI: 72 (61.5, 83.7) mm Hg versus 85.6 (74.5, 94.4) mm Hg (p<0.0001). According to the results of logistic regression analysis, a relationship between high IAP values and the development of acute kidney injury was revealed: the odds ratio (OR) was 3.4 with the value of the criterion χ2=32.4 (р<0.0001). The odds ratio between the reduction of APP and the development of AKI was 2.3 with the value of the criterion χ2=13.4 (p=0.0002). ROC analysis showed that IAP >10.4 mm Hg is the threshold level for the development of AKI with a sensitivity of 46% and a specificity of 90.5%, with an area under the AUC curve of 0.74 (p<0.001). APP <79.12 mm Hg is critical for the development of AKI, with a sensitivity of 66.4% and a specificity of 70%, with an area under the AUC curve of 0.68 (p<0.001). Conclusions. High values of IAP and reduction of APP are associated with the occurrence of acute kidney injury in elderly patients after emergency abdominal surgery. IAP is a less sensitive but more specific marker of AKI development than APP.
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