Acute Pancreatitis with Abdominal Compartment Syndrome Is Strongly Associated with Increased Risk of Kidney Complications: A Multi-Institutional, Real-World Study

Background: Abdominal compartment syndrome (ACS) is a rare but critical complication of acute pancreatitis (AP), often contributing to multi-organ dysfunction. Its impact on kidney-related outcomes, including acute kidney injury (AKI), dialysis need, and mortality, remains incompletely defined in large real-world datasets. Methods: Using the TriNetX Global Collaborative Network (148 HCOs), we identified adults (≥18 years) diagnosed with AP between 2005–2025. We compared two cohorts: AP with ACS (n=1,570) vs. AP without ACS (n=649,344). ACS was defined by ICD-10 codes for abdominal compartment syndrome. Outcomes were assessed within 30 days post-index diagnosis and included: AKI (ICD-10:N17), end-stage renal disease (ESRD: Z99.2, N18.6), need for continuous renal replacement therapy (CRRT), vasopressor use, and all-cause mortality. Risk analyses, Kaplan-Meier survival curves, and hazard ratios (HR) were calculated. Results: Patients with AP and ACS had markedly worse nephrology-related outcomes compared to those without ACS: AKI: 38.7% vs. 6.0% (RR 6.47, OR 9.92; p<0.001) ESRD: 8.8% vs. 1.5% (RR 5.85, OR 6.32; p<0.001) CRRT: 22.4% vs. 0.6% (RR 35.5, OR 45.4; p<0.001) Vasopressor use: 11.4% vs. 0.6% (RR 19.2, OR 21.6; p<0.001) 30-day Mortality: 24.3% vs. 2.1% (RR 11.4, OR 14.7; p<0.001) Kaplan-Meier survival analysis demonstrated significantly reduced survival probabilities in the AP+ACS group for all outcomes, with hazard ratios ranging from 6.3 (ESRD) to 40.7 (CRRT). Conclusion: In this large real-world cohort, abdominal compartment syndrome in the setting of acute pancreatitis was associated with dramatically higher risks of AKI, dialysis need, vasopressor use, and mortality. These findings underscore the need for early identification and aggressive management of ACS to mitigate renal complications and improve outcomes.