Top

European Journal of Trauma and Emergency Surgery

Published in:

Open Access 01-04-2022 | Hypertension | Original Article

Prevalence of intra-abdominal hypertension and markers for associated complications among severe burn patients: a multicenter prospective cohort study (BURNIAH study)

Authors: Steven G. Strang, Roelf S. Breederveld, Berry I. Cleffken, Michael H. J. Verhofstad, Oscar J. F. Van Waes, Esther M. M. Van Lieshout

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2022

Abstract

Purpose

Severely burned patients are at risk for intra-abdominal hypertension (IAH) and associated complications such as organ failure, abdominal compartment syndrome (ACS), and death. The aim of this study was to determine the prevalence of IAH among severely burned patients. The secondary aim was to determine the value of urinary intestinal fatty acid binding protein (I-FABP) as early marker for IAH-associated complications.

Methods

A prospective observational study was performed in two burn centers in the Netherlands. Fifty-eight patients with burn injuries ≥ 15% of total body surface area (TBSA) were included. Intra-abdominal pressure (IAP) and urinary I-FABP, measured every 6 h during 72 h. Prevalence of IAH, new organ failure and ACS, and the value of urinary intestinal fatty acid binding protein (I-FABP) as early marker for IAH-associated complications were determined.

Results

Thirty-one (53%) patients developed IAH, 17 (29%) patients developed new organ failure, but no patients developed ACS. Patients had burns of 29% (P₂₅–P₇₅ 19–42%) TBSA. Ln-transformed levels of urinary I-FABP and IAP were inversely correlated with an estimate of − 0.06 (95% CI − 0.10 to − 0.02; p = 0.002). Maximal urinary I-FABP levels had a fair discriminatory ability for patients with IAH with an area under the ROC curve of 74% (p = 0.001). Urinary I-FABP levels had no predictive value for IAH or new organ failure in severe burn patients.

Conclusions

The prevalence of IAH among patients with ≥ 15% TBSA burned was 53%. None of the patients developed ACS. A relevant diagnostic or predictive value of I-FABP levels in identifying patients at risk for IAH-related complications, could not be demonstrated.

Level of evidence

Level III, epidemiologic and diagnostic prospective observational study.

Strang SG, Van Lieshout EMM, Breederveld RS, Van Waes OJF. A systematic review on intra-abdominal pressure in severely burned patients. Burns. 2014;40(1):9–16.CrossRef

Evers LH, Bhavsar D, Mailander P. The biology of burn injury. Exp Dermatol. 2010;19(9):777–83.CrossRef

Bjorck M, Petersson U, Bjarnason T, Cheatham ML. Intra-abdominal hypertension and abdominal compartment syndrome in nontrauma surgical patients. Am Surg. 2011;77(Suppl 1):S62–6.PubMed

Mbiine R, Alenyo R, Kobusingye O, Kuteesa J, Nakanwagi C, Lekuya HM, Kituuka O, Galukande M. Intra-abdominal hypertension in severe burns: prevalence, incidence and mortality in a sub-Saharan African hospital. Int J Burns Trauma. 2017;7(6):80–7.PubMedPubMedCentral

Ramirez JI, Sen S, Palmieri TL, Greenhalgh DG. Timing of laparotomy and closure in burn patients with abdominal compartment syndrome: effects on survival. J Am Coll Surg. 2018;226(6):1175–80.CrossRef

Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, Duchesne J, Bjorck M, Leppaniemi A, Ejike JC, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190–206.CrossRef

Reintam Blaser A, Regli A, De Keulenaer B, Kimball EJ, Starkopf L, Davis WA, Greiffenstein P, Starkopf J, Incidence RF. Outcomes of Intra-Abdominal Study I. Incidence, risk factors, and outcomes of intra-abdominal hypertension in critically ill patients—a prospective multicenter study (IROI Study). Crit Care Med. 2019;47(4):535–42.CrossRef

Fink MP, Delude RL. Epithelial barrier dysfunction: a unifying theme to explain the pathogenesis of multiple organ dysfunction at the cellular level. Crit Care Clin. 2005;21(2):177–96.CrossRef

Moore FA. The role of the gastrointestinal tract in postinjury multiple organ failure. Am J Surg. 1999;178(6):449–53.CrossRef

10.

Rotstein OD. Pathogenesis of multiple organ dysfunction syndrome: gut origin, protection, and decontamination. Surg Infect (Larchmt). 2000;1(3):217–23 (discussion 23–5).CrossRef

11.

de Haan JJ, Lubbers T, Derikx JP, Relja B, Henrich D, Greve JW, Marzi I, Buurman WA. Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study. Crit Care. 2009;13(3):R86.CrossRef

12.

Gollin G, Marks C, Marks WH. Intestinal fatty acid binding protein in serum and urine reflects early ischemic injury to the small bowel. Surgery. 1993;113(5):545–51.PubMed

13.

Pelsers MM, Hermens WT, Glatz JF. Fatty acid-binding proteins as plasma markers of tissue injury. Clin Chim Acta. 2005;352(1–2):15–35.CrossRef

14.

Ivy ME, Atweh NA, Palmer J, Possenti PP, Pineau M, D’Aiuto M. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma. 2000;49(3):387–91.CrossRef

15.

Strang SG, Habes QLM, Van der Hoven B, Tuinebreijer WE, Verhofstad MHJ, Pickkers P, Van Lieshout EMM, Van Waes OJF. Intestinal fatty acid binding protein as a predictor for intra-abdominal pressure-related complications in patients admitted to the intensive care unit; a prospective cohort study (I-Fabulous study). J Crit Care. 2020. https://doi.org/10.1016/j.jcrc.2020.08.023.

16.

Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984;199(1):28–30.CrossRef

17.

Kanda T, Fujii H, Tani T, Murakami H, Suda T, Sakai Y, Ono T, Hatakeyama K. Intestinal fatty acid-binding protein is a useful diagnostic marker for mesenteric infarction in humans. Gastroenterology. 1996;110(2):339–43.CrossRef

18.

Park SH, Hemmila MR, Wahl WL. Early albumin use improves mortality in difficult to resuscitate burn patients. J Trauma Acute Care Surg. 2012;73(5):1294–7.CrossRef

19.

Ruiz-Castilla M, Barret JP, Sanz D, Aguilera J, Serracanta J, Garcia V, Collado JM. Analysis of intra-abdominal hypertension in severe burned patients: the Vall d’Hebron experience. Burns. 2014;40(4):719–24.CrossRef

20.

Sanchez-Sanchez M, Garcia-de-Lorenzo A, Herrero E, Asensio MJ, Galvan B, Cachafeiro L. Prevalence of intra-abdominal hypertension (IAH) among patients with severe burns. Burns. 2014;40(3):533.CrossRef

21.

Balogh ZJ, Lumsdaine W, Moore EE, Moore FA. Postinjury abdominal compartment syndrome: from recognition to prevention. Lancet. 2014;384(9952):1466–75.CrossRef

22.

Balogh ZJ, Martin A, van Wessem KP, King KL, Mackay P, Havill K. Mission to eliminate postinjury abdominal compartment syndrome. Arch Surg. 2011;146(8):938–43.CrossRef

23.

Kanda T, Tsukahara A, Ueki K, Sakai Y, Tani T, Nishimura A, Yamazaki T, Tamiya Y, Tada T, Hirota M, et al. Diagnosis of ischemic small bowel disease by measurement of serum intestinal fatty acid-binding protein in patients with acute abdomen: a multicenter, observer-blinded validation study. J Gastroenterol. 2011;46(4):492–500.CrossRef

24.

Sun DL, Cen YY, Li SM, Li WM, Lu QP, Xu PY. Accuracy of the serum intestinal fatty-acid-binding protein for diagnosis of acute intestinal ischemia: a meta-analysis. Sci Rep. 2016;6:34371.CrossRef

25.

Thuijls G, van Wijck K, Grootjans J, Derikx JP, van Bijnen AA, Heineman E, Dejong CH, Buurman WA, Poeze M. Early diagnosis of intestinal ischemia using urinary and plasma fatty acid binding proteins. Ann Surg. 2011;253(2):303–8.CrossRef

26.

Vermeulen Windsant IC, Hellenthal FA, Derikx JP, Prins MH, Buurman WA, Jacobs MJ, Schurink GW. Circulating intestinal fatty acid-binding protein as an early marker of intestinal necrosis after aortic surgery: a prospective observational cohort study. Ann Surg. 2012;255(4):796–803.CrossRef

27.

Montagnana M, Danese E, Lippi G. Biochemical markers of acute intestinal ischemia: possibilities and limitations. Ann Transl Med. 2018;6(17):341.CrossRef

Title: Prevalence of intra-abdominal hypertension and markers for associated complications among severe burn patients: a multicenter prospective cohort study (BURNIAH study)
Authors: Steven G. Strang
Roelf S. Breederveld
Berry I. Cleffken
Michael H. J. Verhofstad
Oscar J. F. Van Waes
Esther M. M. Van Lieshout
Publication date: 01-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Hypertension
Abdominal Compartment Syndrome
Hypertension
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01623-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prevalence of intra-abdominal hypertension and markers for associated complications among severe burn patients: a multicenter prospective cohort study (BURNIAH study)

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 2/2022

Posterior tibial plateau fracture treatment with the new WAVE posterior proximal tibia plate: feasibility and first results

Prevalence and outcome of contrast-induced nephropathy in major trauma patients

The use of Verbrugge forceps for reduction of the posterior column element in displaced acetabular fractures: clinical and radiological evaluation

The effect of age and sex on outcomes following isolated moderate to severe traumatic brain injury

The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

Tertiary peritonitis: considerations for complex team-based care