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Minerva Anestesiologica 2014 March;80(3):293-306


language: English

A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!)

Malbrain M. L. N. G. 1, Chiumello D. 2, Cesana B. M. 3, Reintam Blaser A. 4, 5, Starkopf J. 4, Sugrue M. 6, Pelosi P. 7, Severgnini P. 7, Hernandez G. 8, Brienza N. 9, Kirkpatrick A. W. 10, Schachtrupp A. 11, Kempchen J. 11, Estenssoro E. 12, Vidal M. G. 12, De Laet I. 1, De Keulenaer B. L. 13

1 Intensive Care Unit, ZiekenhuisNetwerk Antwerpen, ZNA Stuivenberg, Antwerpen, Belgium; 2 Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCSS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy; 3 Biostatistics and Biomathematics Unit, DMMT, University of Brescia, Brescia, Italy; 4 Clinic of Anesthesiology and Intensive Care Medicine, Tartu University Hospital and University of Tartu, Tartu, Estonia; 5 Department of Intensive Care Medicine University Hospital (Inselspital) and University of Bern, Bern, Switzerland; 6 Letterkenny General Hospital, Letterkenny, Ireland; 7 Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genoa, Italy; 8 Department of Intensive Care Medicine, Pontificia Universidad Catòlica De Chile, Santiago, Chile; 9 Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; 10 Regional Trauma Services, Foothills Medical Center, Calgary, Alberta, Canada; 11 Department of Surgery, University hospital RWTH Aachen, Aachen, Germany; 12 Servicio de Terapia Intensiva, Hospital Interzonal de Agudos General San Martin, La Plata, Buenos Aires, Argentina; 13 Intensive Care Unit, Fremantle Hospital, Fremantle, Western Australia, Australia


Intra-abdominal hypertension (IAH), defined as a pathologically increase in intraabdominal pressure, is commonly found in critically ill patients. While IAH has been associated with several abdominal as well as extra-abdominal conditions, few studies have examined the occurrence of IAH in relation to mortality. The aim of this paper was to evaluate the prognostic role of IAH and its risk factors at admission in critically ill patients across a wide range of settings and countries. An individual patient meta-analysis of all available data and a systematic review of published (in full or as abstract) medical databases and studies between 1996 and June 2012 were performed. The search was limited to “clinical trials” and “randomized controlled trials”, “adults”, using the terms “intra-abdominal pressure”, “intraabdominal hypertension” combined with any of the terms “outcome” and “mortality”. All together data on 2707 patients, representing 21 centers from 11 countries was obtained. Data on 1038 patients were not analysed because of the following exclusion criteria: no IAP value on admission (N.=712), absence of information on ICU outcome (N.=195), age <18 or >95 years (N.=131). Data from 1669 individual patients (19 centers from 9 countries) were analyzed in the meta-analysis. Presence of IAH was defined as a sustained increase in IAP equal to or above 12 mmHg. At admission the mean overall IAP was 9.9±5.0 mmHg, with 463 patients (27.7%) presenting IAH with a mean IAP of 16.3±3.4 mmHg. The only independent predictors for IAH were SOFA score and fluid balance on the day of admission. Five hundred thirteen patients (30.8%) died in intensive care. The independent predictors for intensive care mortality were IAH, SAPS II score, SOFA score and admission category. This systematic review and individual patient data meta-analysis shows that IAH is frequently present in critically ill patients and it is an independent predictor for mortality.

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