Relationship between intra-abdominal pressure and indocyanine green plasma disappearance rate: hepatic perfusion may be impaired in critically ill patients with intra-abdominal hypertension

摘要

Background Monitoring hepatic blood flow and function might be crucial in treating critically ill patients. Intra-abdominal hypertension is associated with decreased abdominal blood flow, organ dysfunction, and increased mortality. The plasma disappearance rate (PDR) of indocyanine green (ICG) is considered to be a compound marker for hepatosplanchnic perfusion and hepatocellular membrane transport and correlates well with survival in critically ill patients. However, correlation between PDR_ICG and intra-abdominal pressure (IAP) remains poorly understood. The aim of this retrospective study was to investigate the correlation between PDR_ICG and classic liver laboratory parameters, IAP and abdominal perfusion pressure (APP). The secondary goal was to evaluate IAP, APP, and PDR_ICG as prognostic factors for mortality. Methods A total of 182 paired IAP and PDR_ICG measurements were performed in 40 critically ill patients. The mean values per patient were used for comparison. The IAP was measured using either a balloon-tipped stomach catheter connected to an IAP monitor (Spiegelberg, Hamburg, Germany, or CiMON, Pulsion Medical Systems, Munich, Germany) or a bladder FoleyManometer (Holtech Medical, Charlottenlund, Denmark). PDR_ICG was measured at the bedside using the LiMON device (Pulsion Medical Systems, Munich, Germany). Primary endpoint was hospital mortality. Results There was no significant correlation between PDR_ICG and classic liver laboratory parameters, but PDR_ICG did correlate significantly with APP ( R = 0.62) and was inversely correlated with IAP ( R = -0.52). Changes in PDR_ICG were associated with significant concomitant changes in APP ( R = 0.73) and opposite changes in IAP ( R = 0.61). The IAP was significantly higher (14.6 ± 4.6 vs. 11.1 ± 5.3 mmHg, p = 0.03), and PDR_ICG (10 ± 8.3 vs. 15.9 ± 5.2%, p = 0.02) and APP (43.6 ± 9 vs. 57.9 ± 12.2 mmHg, p Conclusions PDR_ICG is positively correlated to APP and inversely correlated to IAP. Changes in APP are associated with significant concomitant changes in PDR_ICG, while changes in IAP are associated with opposite changes in PDR_ICG, suggesting that an increase in IAP may compromise hepatosplanchnic perfusion. Both PDR_ICG and IAP are correlated with outcome. Measurement of PDR_ICG may be a useful additional clinical tool to assess the negative effects of increased IAP on liver perfusion and function.