Role of intra-abdominal pressure in early acute kidney injury: A prospective cohort study in critically Ill obstetric patients

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Mahendra Kumar
2. Gaurav Verma
3. Shubham Lahan
ISSN
0972-5229
DOI
10.4103/ijccm.IJCCM_170_18
Volume
22
Issue
8
Publishing Year
2018
Pages
6
Author Affiliations
    1. Guru Teg Bahadur Hospital, New Delhi, India
    1. Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
    1. Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
  • Article keywords
    Acute kidney injury, intra-abdominal hypertension, intra-abdominal pressure

    Abstract

    Aims: This prospective cohort study evaluated intra-abdominal pressure (IAP) and its role in causing acute kidney injury (AKI) in critically ill obstetric patients and utility of urinary neutrophil gelatinase-associated lipocalin (NGAL) to predict AKI. Methods: A total of 50 eligible obstetric patients admitted to our Intensive Care Unit were enrolled and daily IAP measured using indwelling Foley catheter. Early AKI was diagnosed as per the KDIGO criteria and urine assessed for NGAL using ELISA. Results: AKI was seen in 54% and intra-abdominal hypertension (IAH) in 21% patients. In patients with and without AKI, there was statistically similar IAP on day 1 (P = 0.542) and day 2 (P = 0.907) as well as incidence of IAH (19% vs. 23%) (P = 0.766). Area under receiver operating characteristic curve (AUC) for IAP to predict early AKI was 0.499 (95% confidence interval [CI]: 0.325–0.673) (P = 0.992). Urinary NGAL concentration was significantly greater in patients with early AKI compared to those without (P = 0.006); AUC for urinary NGAL to detect early AKI was 0.734 (95% CI: 0.583–0.884) (P = 0.006) and optimal cutoff was 53.7 ng/ml. Conclusions: IAH and AKI are common in critically ill obstetric patients. While IAP does not correlate with early AKI, NGAL is useful to predict AKI.

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