Intra-abdominal hypertension as a risk factor of death in patients with severe sepsis or septic shock

Introduction

Critically ill patients with severe sepsis or septic shock have a very high mortality rate. The aim of our study was to investigate the impact of intra-abdominal hypertension (IAH) on the outcome of patients with or without severe sepsis/septic shock.

Methods

Two hundred and fifty-three mechanically ventilated patients admitted to the general ICU of Tartu University Hospital were prospectively studied. Patients who had severe sepsis or septic shock at admission or developed it during their first week of stay were compared with patients not suffering from severe sepsis. IAH was defined as sustained intra-abdominal pressure above or equal to 12 mmHg developing within the first week in the ICU.

Results

Severe sepsis or septic shock was observed in 123 patients (48.6%). The ICU mortality among these patients was 33.3% compared with 18.5% in nonseptic patients (P = 0.005). IAH developed in 95 patients (37.0%). The incidence of IAH was higher among septic patients (45.5% vs 28.5%, P = 0.004). Those septic patients who developed IAH had a mortality rate of 50.0% compared with 19.4% in septic patients without IAH (P < 0.001). Mortality among nonseptic patients was not different between the patients with or without IAH (18.9% vs 18.3%). Development of IAH was a significant risk factor for death in septic patients (OR 4.15; 95% CI 1.87–9.26), but not in nonseptic patients (OR 1.04; 95% CI 0.39–2.77).

Conclusion

Development of IAH significantly increases the risk of death in patients with severe sepsis or septic shock, but not in nonseptic patients.