P0022 - Cumulative Intra-Abdominal Pressure Exposure and Dynamic Trajectories in ICU-Admitted Patients Reveal Prognostic Determinants of Severe Acute Pancreatitis

Maobin Kuang, PhD¹, Yaoyu Zou, MD², Shixuan Xiong, ², Cong He, PhD¹, Nianshuang Li, PhD¹, Jianhua Wan, PhD², Yin Zhu, PhD²
1Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchan, Nanchang, Jiangxi, China; 2The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

Introduction: Intra-abdominal pressure (IAP) critically drives organ failure progression in severe acute pancreatitis (SAP). However, traditional static IAP monitoring inadequately captures dynamic injury evolution. This study aimed to assess the impact of cumulative IAP exposure (CumIAP) and dynamic trajectories on the prognosis of SAP.

Methods: This retrospective cohort study analyzed 1,008 ICU-admitted SAP patients from the Jiangxi cohort (2005-2023) and 83 from MIMIC-IV (2008-2019). CumIAP was quantified via time-weighted integration of serial IAP measurements. Multivariate Cox regression models and restricted cubic splines (RCS) were established to analyze the dose-response relationships between CumIAP and death, infectious pancreatic necrosis (IPN), and persistent multiple organ failure (PMOF). Mediation analysis evaluated CumIAP's role in albumin (ALB)- and acute necrotic collection (ANC)-associated outcomes. Latent class growth mixture model (LCGMM) was used to identify dynamic IAP trajectory subtypes, and the associations between each trajectory group and poor prognosis were analyzed.

Results: During the median 17-day inpatient follow-up of the subjects in the Jiangxi cohort, 200 individuals (19.8%), 208 individuals (20.6%), and 329 individuals (32.6%) experienced in-hospital death, IPN, and PMOF, respectively. Regression analysis revealed that for each standard deviation increase in CumIAP, the risks of in-hospital death and PMOF increased by 37% and 86%, respectively, and there was a U-shaped association with the risk of IPN occurrence (P for nonlinearity = 0.004). Mediation analysis showed that CumIAP mediated 24.26% and 33.76% of the associations between ALB, ANC, and the risk of in-hospital death, respectively. Three IAP trajectories were identified by LCGMM: the high-pressure rapid decline group (HRD-T1), the low-pressure gradual decline group (LGD-T2), and the low-pressure progressive increase group (LPI-T3). Among them, compared with HRD-T1 and LGD-T2, the subjects in the LPI-T3 group had a significantly increased risk of poor prognosis.

Discussion: This study, for the first time, revealed that CumIAP is linearly positively correlated with death and PMOF, while it exhibits a U-shaped association with IPN. Moreover, the risk of poor prognosis in the trajectory group with a low baseline IAP but progressive increase is significantly higher than that in the group with a high baseline IAP but rapid decline.


Figure: Restricted Cubic Spline Regression Analysis between CumIAP and the Risk of Death, SAP, IPN, and PMOF, respectively. CumIAP: Cumulative Intra-abdominal Pressure; IPN: Infected Pancreatic Necrosis; PMOF: Persistent Multiple Organ Failure.


Figure: Potential Class Change Trajectories of IAP in Subjects form Nanchang Cohort (n=1,008). IAP: Intra-abdominal Pressure; LGD: Low-pressure Gradual Decline; HRD: High-pressure Rapid Decline; LPI: Low-pressure Progressive Increase.

Disclosures:
Maobin Kuang indicated no relevant financial relationships.
Yaoyu Zou indicated no relevant financial relationships.
Shixuan Xiong indicated no relevant financial relationships.
Cong He indicated no relevant financial relationships.
Nianshuang Li indicated no relevant financial relationships.
Jianhua Wan indicated no relevant financial relationships.
Yin Zhu indicated no relevant financial relationships.

Maobin Kuang, PhD¹, Yaoyu Zou, MD², Shixuan Xiong, ², Cong He, PhD¹, Nianshuang Li, PhD¹, Jianhua Wan, PhD², Yin Zhu, PhD². P0022 - Cumulative Intra-Abdominal Pressure Exposure and Dynamic Trajectories in ICU-Admitted Patients Reveal Prognostic Determinants of Severe Acute Pancreatitis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.