{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:10:27Z","timestamp":1788930627132,"version":"build-2803163510"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Liver cirrhosis and ascites are risk factors for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); however, data is scarce. We aimed to determine the prevalence of IAH\/ACS in a population of critically ill cirrhotic patients with acute medical illness in intensive care and to assess for risk factors and clinical outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a multicentric retrospective cohort study including two general ICUs and pooled data from a multicentric study between January 2009 and October 2019.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 9,345 patients were screened, and 95 were included in the analysis. Mean age was 56.7\u00b11.3 years, and 79% were male. Liver cirrhosis etiology included alcohol in 45.3% and alcohol plus hepatitis C virus in 9.5%. Precipitating events included infection in 26% and bleeding in 21% of cases. Mean severity score MELD and SAPS II were 26.2\u00b19.9 and 48.5\u00b115.3, respectively, at ICU admission. The prevalence of IAH and ACS was respectively 82.1% and 23.2% with a mean value of maximum IAP of 16.0\u00b15.7 mmHg and IAH grades: absent 17.9%, I 26.3%, II 33.7%, III 17.9%, and IV 4.2%. Independent risk factors for IAH were alcoholic cirrhosis (p = 0.01), West-Haven score (p = 0.01), and PaO2\/FiO2 ratio (p = 0.02); as well as infection (p = 0.048) for ACS. Overall, 28-day mortality was 52.6% associated with higher IAP and ACS, and independent risk factors were MELD (p = 0.001), white blood cell count (p = 0.03), PaO2\/FiO2 ratio (p = 0.03), and lactate concentration (p = 0.04) at ICU admission.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study demonstrates a very high prevalence of IAH\/ACS in the critically ill cirrhotic patient in intensive care. Increased IAP and ACS were associated with severity of disease and adverse outcomes and independent risk factors for IAH were alcoholic cirrhosis, hepatic encephalopathy and PO2\/FiO2 ratio, as well as infection for ACS. Early diagnosis, prevention, and treatment of IAH\/ACS might improve outcome in critically ill cirrhotic patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0251498","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T17:45:31Z","timestamp":1620927931000},"page":"e0251498","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":26,"title":["Intra-abdominal hypertension and abdominal compartment syndrome in the critically ill liver cirrhotic patient\u2013prevalence and clinical outcomes. A multicentric retrospective cohort study in intensive care"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3010-8384","authenticated-orcid":true,"given":"Rui","family":"Pereira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Buglevski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Perdigoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Marcelino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faouzi","family":"Saliba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stijn","family":"Blot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Starkopf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"issue":"7","key":"pone.0251498.ref001","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1007\/s00134-013-2906-z","article-title":"Intra-abdominal hypertension and the abdominal compartment syndrome: Updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome.","volume":"39","author":"AW Kirkpatrick","year":"2013","journal-title":"Intensive Care Med"},{"issue":"1","key":"pone.0251498.ref002","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13017-015-0016-7","article-title":"The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study.","volume":"10","author":"K-H Kyoung","year":"2015","journal-title":"World J Emerg Surg"},{"issue":"5","key":"pone.0251498.ref003","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1007\/s00134-004-2169-9","article-title":"Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study.","volume":"30","author":"MLNG Malbrain","year":"2004","journal-title":"Intensive Care Med"},{"issue":"2","key":"pone.0251498.ref004","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/01.CCM.0000153408.09806.1B","article-title":"Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: A multiple-center epidemiological study.","volume":"33","author":"MLNG Malbrain","year":"2005","journal-title":"Crit Care Med"},{"issue":"4","key":"pone.0251498.ref005","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1097\/CCM.0000000000003623","article-title":"Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients\u2014A Prospective Multicenter Study (IROI Study).","volume":"47","author":"A Reintam Blaser","year":"2019","journal-title":"Crit Care Med."},{"key":"pone.0251498.ref006","first-page":"1061","article-title":"Abdominal compartment syndrome: Improving outcomes with a multidisciplinary approach\u2013a narrative reviewJournal of Multidisciplinary Healthcare.","volume":"12","author":"M Padar","year":"2019"},{"issue":"1","key":"pone.0251498.ref007","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1053\/jhep.2003.50315","article-title":"The management of ascites in cirrhosis: Report on the consensus conference of The International Ascites Club","volume":"38","author":"KP Moore","year":"2003","journal-title":"Hepatology"},{"key":"pone.0251498.ref008","first-page":"397","article-title":"EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis","author":"European Association for the Study of the Liver","year":"2010","journal-title":"Journal of Hepatology Sep"},{"key":"pone.0251498.ref009","article-title":"Epidemiology of intra-abdominal infection and sepsis in critically ill patients: \u201cAbSeS\u201d, a multinational observational cohort study and ESICM Trials Group Project.","author":"S Blot","year":"2019","journal-title":"Intensive Care Med."},{"issue":"2","key":"pone.0251498.ref010","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/MCC.0b013e328344b42d","article-title":"Acute-on-chronic liver failure: concept, natural history, and prognosis.","volume":"17","author":"JC Olson","year":"2011","journal-title":"Curr Opin Crit Care"},{"issue":"10","key":"pone.0251498.ref011","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1097\/00003246-198510000-00009","article-title":"APACHE II: a severity of disease classification system.","volume":"13","author":"WA Knaus","year":"1985","journal-title":"Crit Care Med"},{"key":"pone.0251498.ref012","article-title":"A New Simplified Acute Physiology Score (SAPS II) Based on a European\/North American Multicenter Study.","author":"JR Gall","year":"1993","journal-title":"JAMA J Am Med Assoc"},{"key":"pone.0251498.ref013","article-title":"A model to predict survival in patients with end-stage liver disease","author":"PS Kamath","year":"2001","journal-title":"Hepatology"},{"key":"pone.0251498.ref014","article-title":"Hyponatremia and mortality among patients on the liver-transplant waiting list","author":"WR Kim","year":"2008","journal-title":"N Engl J Med"},{"issue":"10","key":"pone.0251498.ref015","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1097\/00003246-198510000-00009","article-title":"APACHE II: A severity of disease classification system.","volume":"13","author":"WA Knaus","year":"1985","journal-title":"Crit Care Med"},{"issue":"4","key":"pone.0251498.ref016","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1053\/he.2000.5852","article-title":"A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts","volume":"31","author":"M Malinchoc","year":"2000","journal-title":"Hepatology"},{"issue":"7","key":"pone.0251498.ref017","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1053\/j.gastro.2013.02.042","article-title":"Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis","volume":"144","author":"R Moreau","year":"2013","journal-title":"Gastroenterology"},{"key":"pone.0251498.ref018","first-page":"951","article-title":"Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations","author":"ML Cheatham","year":"2007","journal-title":"In: Intensive Care Medicine"},{"key":"pone.0251498.ref019","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1007\/s00134-006-0349-5","article-title":"Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions","author":"MLNG Malbrain","year":"2006","journal-title":"Intensive Care Medicine"},{"key":"pone.0251498.ref020","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s13054-020-2782-1","article-title":"A Clinician\u2019s Guide to Management of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients","volume":"24","author":"IE De Laet","journal-title":"Critical Care."},{"key":"pone.0251498.ref021","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.jhep.2015.10.019","article-title":"Management of the critically ill patient with cirrhosis: A multidisciplinary perspective","author":"MK Nadim","year":"2016","journal-title":"Journal of Hepatology"},{"key":"pone.0251498.ref022","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1186\/2110-5820-2-S1-S4","article-title":"Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock","volume":"2012","author":"HM Al-Dorzi","year":"2012","journal-title":"Ann Intensive Care"},{"issue":"18","key":"pone.0251498.ref023","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1503\/cmaj.090707","article-title":"Low-dose hydrocortisone in patients with cirrhosis and septic shock: A randomized controlled trial.","volume":"182","author":"YM Arabi","year":"2010","journal-title":"CMAJ"},{"key":"pone.0251498.ref024","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1179\/acb.2007.62.s1.012","article-title":"The influence of intra-abdominal hypertension on the central nervous system: Current insights and clinical recommendations, is it all in the head?","author":"I De Laet","year":"2007","journal-title":"Acta Clinica Belgica"},{"issue":"11","key":"pone.0251498.ref025","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1007\/s00134-005-2802-2","article-title":"Correlation between intra-abdominal and intracranial pressure in nontraumatic brain injury.","volume":"31","author":"DH Deeren","year":"2005","journal-title":"Intensive Care Med"},{"key":"pone.0251498.ref026","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/TA.0b013e31822a3254","article-title":"Intra-abdominal hypertension causes reversible blood-brain barrier disruption","author":"AM Youssef","year":"2012","journal-title":"Journal of Trauma and Acute Care Surgery"},{"issue":"12","key":"pone.0251498.ref027","first-page":"CR548","article-title":"Changes in intra-abdominal pressure and central venous and brain venous blood pressure in patients during extracorporeal circulation","volume":"13","author":"W Dabrowski","year":"2007","journal-title":"Med Sci Monit"},{"issue":"7","key":"pone.0251498.ref028","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1097\/00003246-200107000-00027","article-title":"Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: A prospective study.","volume":"29","author":"G Citerio","year":"2001","journal-title":"Crit Care Med"},{"issue":"2","key":"pone.0251498.ref029","doi-asserted-by":"crossref","DOI":"10.1186\/cc8908","article-title":"Ischemia as a possible effect of increased intra-abdominal pressure on central nervous system cytokines, lactate and perfusion pressures.","volume":"14","author":"A Marinis","year":"2010","journal-title":"Crit Care."},{"key":"pone.0251498.ref030","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1177\/0271678X16648711","article-title":"Monro-Kellie 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure","volume":"36","author":"MH Wilson","year":"2016","journal-title":"Journal of Cerebral Blood Flow and Metabolism"},{"key":"pone.0251498.ref031","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s00701-019-03868-7","article-title":"The significance of intra-abdominal pressure in neurosurgery and neurological diseases: a narrative review and a conceptual proposal.","volume":"161","author":"PRAM Depauw","year":"2019","journal-title":"Acta Neurochirurgica."},{"issue":"1","key":"pone.0251498.ref032","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s13613-017-0249-6","article-title":"Prognosis of cirrhotic patients admitted to intensive care unit: a meta-analysis.","volume":"7","author":"D Weil","year":"2017","journal-title":"Ann Intensive Care."},{"issue":"1","key":"pone.0251498.ref033","doi-asserted-by":"crossref","first-page":"49","DOI":"10.5935\/0103-507X.20200009","article-title":"Acute-on-chronic liver failure syndrome\u2014clinical results from an intensive care unit in a liver transplant center","volume":"32","author":"R Pereira","year":"2020","journal-title":"Rev Bras Ter intensiva"},{"issue":"1","key":"pone.0251498.ref034","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1159\/000478988","article-title":"Acute-on-Chronic Liver Failure: A Portuguese Single-Center Reference Review.","volume":"25","author":"M Verdelho","year":"2018","journal-title":"GE Port J Gastroenterol"},{"issue":"7","key":"pone.0251498.ref035","doi-asserted-by":"crossref","first-page":"liv.14083","DOI":"10.1111\/liv.14083","article-title":"Lactate and number of organ failures predict intensive care unit mortality in patients with acute\u2010on\u2010chronic liver failure","volume":"39","author":"FS Cardoso","year":"2019","journal-title":"Liver Int"},{"issue":"5","key":"pone.0251498.ref036","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1016\/j.jhep.2014.06.012","article-title":"Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure","volume":"61","author":"R Jalan","year":"2014","journal-title":"J Hepatol"},{"issue":"3","key":"pone.0251498.ref037","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.jcrc.2010.08.020","article-title":"Respiratory impact of paracentesis in cirrhotic patients with acute lung injury","volume":"26","author":"E Levesque","year":"2011","journal-title":"J Crit Care"},{"issue":"1","key":"pone.0251498.ref038","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1471-230X-14-18","article-title":"Effects of paracentesis on hemodynamic parameters and respiratory function in critically ill patients.","volume":"14","author":"V Phillip","year":"2014","journal-title":"BMC Gastroenterol."},{"issue":"3","key":"pone.0251498.ref039","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0193654","article-title":"Impact of large volume paracentesis on respiratory parameters including transpulmonary pressure and on transpulmonary thermodilution derived hemodynamics: A prospective study.","volume":"13","author":"U Mayr","year":"2018","journal-title":"PLoS One."},{"issue":"1","key":"pone.0251498.ref040","doi-asserted-by":"crossref","DOI":"10.1186\/s13613-018-0422-6","article-title":"Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension","volume":"8","author":"U Mayr","year":"2018","journal-title":"Ann Intensive Care"},{"issue":"1","key":"pone.0251498.ref041","doi-asserted-by":"crossref","DOI":"10.1186\/cc6765","article-title":"Effects of plasma expansion with albumin and paracentesis on haemodynamics and kidney function in critically ill cirrhotic patients with tense ascites and hepatorenal syndrome: A prospective uncontrolled trial.","volume":"12","author":"A Umgelter","year":"2008","journal-title":"Crit Care."},{"key":"pone.0251498.ref042","unstructured":"Pereira, Rui (Hospital Curry Cabral C. Continuous Passive Paracentesis for Intra-abdominal Hypertension\u2014Full Text View\u2014ClinicalTrials.gov [Internet]. [cited 2020 May 29]. Available from: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04322201."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251498","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T17:46:13Z","timestamp":1620927973000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251498"}},"subtitle":[],"editor":[{"given":"Aleksandar R.","family":"Zivkovic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,13]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0251498","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,13]]}}}