Acute Kidney Injury Secondary to Abdominal Compartment Syndrome: Biomarkers, Pressure Variability, and Clinical Outcomes

Abdominal compartment syndrome (ACS) is a severe clinical condition caused by in-tra-abdominal hypertension (IAH), often observed in surgical and trauma patients. However, ACS can also develop in non-surgical patients with massive ascites, leading to acute kidney injury (AKI) due to renal hypoperfusion. This study investigates the association between intra-abdominal pressure (IAP) changes, renal biomarkers, and mortality in patients with ACS-related AKI. A prospective cohort study was conducted on 24 hospitalized patients with asci-tes due to malignancy, cirrhosis, or heart failure. IAP was measured via the trans-vesical method on the 1st and 7th days of hospitalization. Serum and urinary biomarkers, including kidney injury molecule-1 (KIM-1), neutrophil gelati-nase-associated lipocalin (NGAL), and interleukin-6 (IL-6), were assessed for their cor-relation with IAP changes. The primary outcome was in-hospital mortality, and sec-ondary outcomes included AKI progression and the effect of paracentesis on IAP re-duction. The overall in-hospital mortality rate was 50%. Patients who survived had sig-nificantly lower IAP on the 7th day compared to those who died (14.9 ± 3.5 mmHg vs. 20.2 ± 5.6 mmHg, p = 0.01). A 25% reduction in IAP was associated with improved kid-ney function and increased survival (p < 0.001). Urinary KIM-1 and serum NGAL levels showed a moderate correlation with IAP (r = 0.55, p = 0.02 and r = 0.61, p = 0.018, re-spectively), while IL-6 levels were significantly higher in non-survivors (p = 0.03). Pa-racentesis was associated with improved survival outcomes (p = 0.04). ACS is a critical but often overlooked cause of AKI in non-surgical patients with massive ascites. Lowering IAP significantly improves renal function and reduces mor-tality. Urinary KIM-1 and serum NGAL may serve as useful biomarkers for monitoring IAP changes. Early identification and management of IAH through timely interven-tions such as paracentesis and volume control strategies could improve patient out-comes.