Abdominal perfusion pressure in critically ill cirrhotic patients: a prospective observational study.

Abstract

Abstract Introduction In critical patients, abdominal perfusion pressure (APP) has been shown to correlate with outcome. However, data from decompensated cirrhotic patients and acute-on-chronic liver failure (ACLF) is scarce. Objectives We aimed to characterize APP in critically ill cirrhotic patients, analyze the prevalence and risk factors of developing abdominal hypoperfusion (AhP) and impact on outcome. Methods A prospective cohort study in a general ICU specialized in liver disease at a tertiary hospital center. Consecutive cirrhotic patients were recruited between October 2016 and December 2021. Results The study included 101 patients, with a mean age of 57.2 (±10.4) years and a female gender proportion of 23.5%. The most frequent etiology of liver disease was alcohol related (51.0%), and infection (37.3%) was the common precipitant leading to ICU admission. ACLF grading (1-3) proportion was 8.9%, 26.7% and 52.5%, respectively. A total of 1274 measurements were performed. At admission, AhP prevalence was 47.5% and mean APP was 63 (±15) mmHg. Patients with baseline AhP had higher 28-day mortality (75.0% vs. 45.2%; p=004), and longer ICU stay (days) (9 [5, 14] vs. 7 [4, 9]; p=0.03). AhP was not an independent risk factor for mortality. Paracentesis at admission was an independent protective factor (aOR 0.23, CI95% 0.06-0.85, p=0.03), while ACLF grading (aOR1.84, 96%C.I. 1.12-3.02, p=0.02) was a risk factor for AhP. Conclusion Critical cirrhotic patients present high prevalence of AhP. Paracentesis was protective and ACLF severity was a risk factor for AhP. A structured strategy for AhP should be considered in the high-risk cirrhotic patient.