Abstract
<title>Abstract</title> <p> Objectives The aim of this retrospective analysis of prospectively collected data was to explore the association of persistent intra- abdominal hypertension (IAH) with the prognosis of predicted severe acute pancreatitis (SAP). Methods Patients with predicted SAP (admission bedside index for severity in acute pancreatitis ≥ 2) and admitted within 72 h from symptom onset between January 2018 and December 2020 in West China Hospital of Sichuan University were assessed. All patients received intra- abdominal pressure (IAP) measurement every 6 h for 72 h. Sensitivity analyses were performed. Results Among 111 patients enrolled, 94 (84.6%) had intra-abdominal pressure (IAP) above 15mmHg, whereas 55 (49.5%) developed persistent IAH (IAP > 15 mmHg for > 48 h). These patients had significantly higher incidence of persistent organ failure (POF), especially respiratory failure, and showed increased acute necrotic collection (ANC), infected pancreatic necrosis, and length of hospital stay. Multivariate analysis confirmed persistent IAH as an independent predictor for POF (OR 23.46, 95% CI 1.89-291.32, <italic>P</italic> = 0.014) and ANC (OR 4.21, 95% CI 1.34–13.12, <italic>P</italic> = 0.014 ). Sensitivity analyses confirmed the robustness of the 48 h threshold. Body mass index ≥ 24 and modified CT severity index (MCTSI) score at admission ≥ 4 were risk factors for persistent IAH. Conclusions Persistent IAH (IAP > 15 mmHg for > 48 h) is independently associated with POF and ANC in patients with predicted SAP. Sensitivity analyses confirmed the robustness of the 48 h threshold. Overweight and pancreatic fluid and/or necrotic collection were independent predictors for persistent IAH, which may aid in early risk stratification. </p>