Impact of 24-hour urine output trajectories on intra-abdominal hypertension risk in acute pancreatitis patients: Insights from MIMIC-IV database.

Background: Intra-abdominal hypertension (IAH) is a common complication in patients with acute pancreatitis (AP), closely associated with reduced urine output. However, relationship between alterations in urine output and IAH in AP patients remains unclear. Methods: A retrospective study was conducted using Medical Information Mart for Intensive Care (MIMIC-IV). The latent class trajectory model was employed to categorize AP patients’ 24-hour urine output trajectories. Logistic regression models were used to examine variations in IAH prevalence among different trajectory classes. Survival curves were plotted to investigate 30-day survival outcomes of AP patients across different trajectory classes. Robustness analysis was performed using inverse probability weighting regression adjustment. Results: One hundred and ninety AP patients were included, and their 24-hour urine output trajectories were categorized using the potential class trajectory model, and the goodness-of-fit statistics showed that the three-class model was the best. Therefore, their 24-hour urine output trajectories were categorized into three classes: class 1 (≤0.5 mL/kg/h), class 2 (1.5–3 mL/kg/h), and class 3 (0.5–1 mL/kg/h). The logistic regression model revealed that, in the fully adjusted model, IAH prevalence was significantly lower in class 2 (1.5–3 mL/kg/h) compared to class 1 (≤0.5 mL/kg/h) (OR = 0.169, 95% CI: 0.033–0.790, P = 0.027). Survival analysis indicated that the survival rate in class 1 was significantly lower than that in class 3 (0.5–1 mL/kg/h) (P < 0.001). Robustness analysis yielded similar results. Sensitivity analyses such as inverse probability weighting further verified the robustness of the above correlation. Conclusion: We found that a persistently low 24-hour urine output trajectory was associated with an increased prevalence of IAH in patients with AP. The results of this study suggest that early urine output trajectory may serve as a potential indicator for identifying high-risk IAH patients and guiding their early intervention, while its clinical efficacy needs to be confirmed by future research.