Inverted U-Shaped Relationship between Central Venous Pressure and Intra-Abdominal Pressure in the Early Phase of Severe Acute Pancreatitis: A Retrospective Study

Chong Yang; Zhiyong Yang; Xinglin Chen; Tao Liu; Shanmiao Gou; Changzhong Chen; Jun Xiao; Xin Jin; Zhiqiang He; Liming Dong; Yushun Zhang; Na Luo; Heshui Wu; Chunyou Wang

doi:10.1371/journal.pone.0128493

Inverted U-Shaped Relationship between Central Venous Pressure and Intra-Abdominal Pressure in the Early Phase of Severe Acute Pancreatitis: A Retrospective Study

PLoS One. 2015 Jun 8;10(6):e0128493. doi: 10.1371/journal.pone.0128493. eCollection 2015.

Authors

Chong Yang¹, Zhiyong Yang², Xinglin Chen³, Tao Liu⁴, Shanmiao Gou², Changzhong Chen⁵, Jun Xiao⁴, Xin Jin⁴, Zhiqiang He², Liming Dong², Yushun Zhang², Na Luo⁶, Heshui Wu², Chunyou Wang²

Affiliations

¹ Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China; Organ Transplant Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, People's Republic of China; School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People's Republic of China.
² Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
³ Key Laboratory of Geriatrics of Health Ministry, Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
⁴ Surgical Oncology-Abdominal Department, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
⁵ Microarray Core Facility, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America.
⁶ Center for Applied English Studies, the University of Hong Kong, Hong Kong, People's Republic of China.

Abstract

Objective: Many studies have indicated that intra-abdominal pressure (IAP) is positively correlated with central venous pressure (CVP) in severe cases. However, although elevated IAP is common in patients with severe acute pancreatitis (SAP), its relationship with CVP remains unclear. Our study aimed to investigate the association of IAP with CVP in early-phase SAP patients.

Methods: In total, 116 SAP patients were included in this retrospective study. On the first day of hospitalization, blood samples were collected for biochemical examination and cytokine concentration monitoring. Additionally, a urinary catheter and right subclavian vein catheter were inserted for IAP and CVP measurement, respectively. Other routine clinical data were also recorded.

Results: Within 24 hours after hospitalization, CVP fluctuated and increased with increasing IAP up to 15.7 mmHg (P = 0.054) but decreased with increasing IAP when the IAP was > 15.7 mmHg (P < 0.001). After adjusting for abdominal perfusion pressure (APP) and mean arterial pressure (MAP), a similar distribution was observed. An inverted U-shaped trend between IAP and CVP was also present in the groups classified according to the patient's sex, local complications, ascites, and serum amylase levels.

Conclusions: CVP and IAP have an inverted U-shaped relationship, with a peak at an IAP of 15.7 mmHg in the early phase of SAP. After this peak, CVP decreases as IAP increases. These results have crucial implications for clinical fluid resuscitation in SAP patients. In particular, because one CVP value might be correlated with different IAP values in patients with the same CVP, the volume of fluid needed might be different.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Abdomen / physiopathology*
Acute Disease
Central Venous Pressure / physiology*
Female
Humans
Linear Models
Male
Middle Aged
Pancreatitis / physiopathology*
Retrospective Studies

Grants and funding

This work was supported by a grant from the National Natural Science Foundation of China (No. 81171840). This funder did not participate in the development of the study or the manuscript, including study design, collection, analysis, or interpretation of the data; writing of the manuscript; or the decision to submit the paper for publication.