Abstract:
Introduction. The clinical value of admission intra-abdominal pressure in patients with decompensated liver cirrhosis
and refractory ascites remains insufficiently defined, particularly in relation to the different phenotypes of ascitic fluid
infection.
Material and methods. An exploratory observational analysis was performed on a structured dataset that included 100
patients with decompensated liver cirrhosis, refractory ascites, and a Child-Pugh class C score. All patients had the results
of the diagnostic paracentesis performed at admission and the transvesical measurement of intra-abdominal pressure
available. Ascitic fluid phenotypes were defined on the basis of the polymorphonuclear cell count and the ascitic culture result: spontaneous bacterial peritonitis, bacterascites, and sterile ascites. Intra-abdominal hypertension was defined as an
intra-abdominal pressure ≥12 mmHg. The primary objective was the comparison of admission intra-abdominal pressure
among phenotypes. The secondary objectives consisted of examining the associations between admission intra-abdominal
pressure and acute kidney injury, sepsis, acute-on-chronic liver failure, and the need for intensive care.
Results. The cohort included 22 patients with spontaneous bacterial peritonitis, 10 with bacterascites, and 68 with sterile ascites. Median admission intra-abdominal pressure differed significantly among phenotypes, being highest in spontaneous bacterial peritonitis and lower in bacterascites and sterile ascites: 16.9 (15.2–17.9), 13.4 (11.7–15.4), and 13.4
(12.1–14.6) mmHg, respectively (p<0.001). Intra-abdominal hypertension was present in all patients with spontaneous
bacterial peritonitis, in 60.0% of those with bacterascites, and in 75.0% of those with sterile ascites. In adjusted logistic
models, each 1-mmHg increase in admission intra-abdominal pressure was independently associated with spontaneous
bacterial peritonitis (odds ratio [OR] 3.06; 95% confidence interval [CI] 1.56–6.02), any infected ascites (OR 1.56; 95% CI
1.20–2.02), sepsis (OR 2.12; 95% CI 1.44–3.12), acute-on-chronic liver failure (OR 1.43; 95% CI 1.09–1.86), and the need
for intensive care (OR 1.40; 95% CI 1.06–1.83), but not with acute kidney injury (OR 0.91; 95% CI 0.73–1.14).
Conclusions. Higher admission intra-abdominal pressure was associated with a higher probability of spontaneous bacterial peritonitis and with a more severe in-hospital course. Admission intra-abdominal pressure did not show an independent association with acute kidney injury and appears to reflect mainly infectious and general clinical severity.
