Bao-Quan Chen, Xiao-Yi Yan, Wan-Ying Jia, Yan-Fen Yang, Xian-Shui Fu, Ke Lv
This preliminary study suggests that clinicians should remain alert to the occurrence of IAH when abnormal ultrasonic markers are screened. Regular intra-abdominal pressure monitoring is recommended in such cases. However, these findings require validation in larger prospective cohorts.
BACKGROUND: Accurately assessing intra-abdominal hypertension (IAH) is of significant clinical importance in laparoscopic pancreaticoduodenectomy (LPD) and severe acute pancreatitis (SAP), which is closely linked to complications and mortality. This study aimed to identify potential ultrasonic markers for screening IAH in patients who underwent LPD for pancreatic cancer and those with SAP.
METHODS: We conducted a retrospective analysis of 27 patients who were diagnosed with pancreatic cancer and underwent LPD, and 19 patients with SAP admitted to the intensive care unit (ICU) from February 2022 to August 2022. Baseline demographic, ultrasonic markers, and clinical records were obtained and analyzed to identify potential ultrasonic markers for screening IAH. The diagnostic performance was assessed using the area under the receiver operating characteristic (ROC) curve (AUROC).
RESULTS: Comparative analysis between the two groups showed that in both the LPD and SAP groups, patients with IAH exhibited significantly lower right diaphragm thickening rate (RDTR) and significantly higher right renal interlobar arterial resistive index (RIRI) than those without IAH (all P<0.05). Univariate analysis and multivariate regression analysis showed that the RIRI and RDTR were independent predictors of IAH in the LPD group (P=0.004 and P=0.025, respectively); and the combination of RIRI and RDTR showed promising diagnostic performance for IAH, with an AUROC of 0.894, sensitivity of 93.33%, and specificity of 91.67%. Meanwhile, for the SAP group, only the RDTR served as the marker for screening IAH with an AUROC of 0.872, a sensitivity of 86.67%, and a specificity of 83.33%.
CONCLUSIONS: This preliminary study suggests that clinicians should remain alert to the occurrence of IAH when abnormal ultrasonic markers are screened. Regular intra-abdominal pressure monitoring is recommended in such cases. However, these findings require validation in larger prospective cohorts.