Mesenchymal stem cell-derived exosomes regulate microglia phenotypes: a promising treatment for acute central nervous system injury.

There is growing evidence that long-term central nervous system (CNS) inflammation exacerbates secondary deterioration of brain structures and functions and is one of the major determinants of disease outcome and progression. In acute CNS injury, brain microglia are among the first cells to respond and play a critical role in neural repair and regeneration. However, microglial activation can also impede CNS repair and amplify tissue damage, and phenotypic transformation may be responsible for this dual role. Mesenchymal stem cell (MSC)-derived exosomes (Exos) are promising therapeutic agents for the treatment of acute CNS injuries due to their immunomodulatory and regenerative properties. MSC-Exos are nanoscale membrane vesicles that are actively released by cells and are used clinically as circulating biomarkers for disease diagnosis and prognosis. MSC-Exos can be neuroprotective in several acute CNS models, including for stroke and traumatic brain injury, showing great clinical potential. This review summarized the classification of acute CNS injury disorders and discussed the prominent role of microglial activation in acute CNS inflammation and the specific role of MSC-Exos in regulating pro-inflammatory microglia in neuroinflammatory repair following acute CNS injury. Finally, this review explored the potential mechanisms and factors associated with MSC-Exos in modulating the phenotypic balance of microglia, focusing on the interplay between CNS inflammation, the brain, and injury aspects, with an emphasis on potential strategies and therapeutic interventions for improving functional recovery from early CNS inflammation caused by acute CNS injury.

Protective Effects of Mesenchymal Stem Cells Against Central Nervous System Injury in Heat Stroke.

BACKGROUND: Heatstroke (HS) is a serious disease caused by central nervous system (CNS) injuries, such as delirium, convulsion, and coma. Currently, mesenchymal stem cells (MSCs) have demonstrated novel neuroprotective effects; therefore, this research explores the neuroprotective effects and mechanisms of MSCs against HS injury. METHODS: HS rat models were induced in a 40°C and 65% humidity environment until the rectal temperature reached 42°C. The verified HS injury model rats were divided into the HS and MSCs-treated groups. Each rat in the treated group was infused with 1x106 MSCs suspended in 0.3 ml physiological saline via the tail vein. The HS- or MSCs-treated rats were further divided into early-stage (3d) and late-stage (28d). HS rat models were induced by a high-temperature and high-humidity environment at a specific time, the mortality was analyzed, and an automatic biochemical analyzer measured levels of liver and kidney function indicators in the blood. The neurons' morphologic changes were observed through Nissl staining, and neurological deficit scores were performed. Moreover, the levels of inflammatory factors in brain tissue were measured using a multi-cytokine detection platform, and the expression of BDNF, phosphorylated TrkB and P38 were detected by the Western Bolt. RESULTS: MSCs injection significantly reduced mortality and alleviated liver and kidney function. Moreover, the neurological deficit and neuronic edema of the hippocampus caused by HS at 3d and 28d were significantly ameliorated by MSCs administration. Specifically, the injection of MSCs inhibited high levels of interleukin (IL)-1ß, IL-6, tumor necrosis factor-α (TNF-α), and IL-17A caused by HS but elevated the levels of IL-10 and IL-13 in the early period (3d); while in the later period (28d), MSCs significantly increased the levels of IL-10 and IL-13 continuously and inhibited the high level of IL-17A. Furthermore, MSCs injection increased the expressions of BDNF and phosphorylated TrkB (BDNF receptor), meanwhile inhibiting the expression of phosphorylated P38 (inflammatory factor) in the brains of HS rats in the early period (3d) but had no significant influence on the later period (28d). CONCLUSION: These results suggested that MSCs injection may provide therapeutic effects for HS in rats by improving liver and kidney function and reducing CNS damage. Moreover, MSCs injection inhibited the brain inflammatory response of HS rats, and the BDNF-TrkB and P38/MAPK signal pathways may be involved, providing a potential mechanism for HS therapy by MSCs administration.

The procalcitonin-to-cortisol ratio is a potential prognostic predictor in sepsis with abdominal source: a retrospective observational study.

BACKGROUND: The aim of the study was to investigate the procalcitonin-to-cortisol ratio (P/C ratio) as a prognostic predictor among septic patients with abdominal source. METHODS: We retrospectively enrolled 132 post-surgery patients between 18 and 90 years old with sepsis of the abdominal source. On the second day of sepsis onset, cortisol, procalcitonin (PCT), Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, C-response protein (CRP), and other baseline characteristics were collected. In addition, the length of ICU stay, length of mechanical ventilation (MV) days, length of shock days, and 28-day mortality were also recorded. Univariate analysis was performed to screen potential risk factors. Stratified analysis was used to identify the interaction among the risk factors. Multivariate analysis was also utilized to demonstrate the relationship between the risk factors and mortality. The receiver operator characteristic (ROC) curve analysis was conducted to evaluate the risk factors. A restricted cubic spline (RCS) demonstrated the association between survival outcome and the P/C ratio variation. RESULTS: A total of twenty-nine patients died, and 103 patients survived within 28 d. There were significant differences in cortisol, PCT, P/C ratio, interleukin (IL)-6, SOFA, and APACHE II scores between the survival and non-survival groups. No significant interaction was observed in the stratified analysis. Logistic regression analysis revealed that P/C ratio (P=0.033) was significantly related to 28-day mortality. Based on ROC curves, P/C ratio (AUC=0.919) had a higher AUC value than cortisol or PCT. RCS analysis depicted a positive relationship between survival possibility and P/C ratio decrement. CONCLUSION: P/C ratio might be a potential prognostic predictor in septic patients with abdominal sources.

Analysis of D-dimer cut-off values for overt DIC diagnosis in exertional heat illness.

ABSTRACT: The International Society on Thrombosis and Haemostasis (ISTH) scoring system has been used for diagnosing overt disseminated intravascular coagulation (DIC). However, the cut-off points of fibrin-related markers remain unclear. The ability of the ISTH DIC score and Multiple Organ Dysfunction (MODS) score to predict mortality in cases of exertional heat illness (EHI) was tested. In the process, 3 different D-dimer cut-off values for diagnosing overt DIC were evaluated.Data were obtained on the first day of hospitalization for 76 patients with EHI. The DIC score was calculated according to the ISTH scoring system using 3 D-dimer cut-off values.In predicting mortality, methods 1 and 2 had the same sensitivity and specificity, which were 85% and 73.2%, respectively. The sensitivity for method 3 was 70%. Furthermore, the specificity of the DIC score for method 3 was 89%, which was higher than that of the other 2 methods. The correlation coefficients of the DIC and MODS scores of these 3 methods were 0.757, 0.748, and 0.756, respectively. For the prediction of mortality, the area under the receiver operating characteristic (ROC) curve for the DIC scores of these 3 methods was 0.838, 0.842, and 0.85, respectively. Furthermore, the area under the ROC curve of the MODS score was 0.927.The DIC score had a certain predictive power of a poor outcome of EHI patients, but this was not better than the MODS score. The present data may serve as a reference in selecting the appropriate D-dimer cut-off point for the ISTH DIC score.

Establishment and effectiveness evaluation of a scoring system for exertional heat stroke by retrospective analysis.

BACKGROUND: Heat stroke (HS) is a serious, life-threatening disease. However, there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke (EHS). METHODS: Data were collected from a total of 170 exertional heat stroke (EHS) patients between 2005 and 2016 from 52 hospitals in China. Univariate statistical methods and comparison of the area under the receiver operating characteristic (ROC) curve (AUC) were used to screen exertional heat stroke score (EHSS) parameters, including but not limited body temperature (T), Glasgow Coma Scale (GCS) and others. By comparing the sizes of the AUCs of the APACHE II, SOFA and EHSS assessments, the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified. RESULTS: Through screening with a series of methods, as described above, the present study determined 12 parameters - body temperature (T), GCS, pH, lactate (Lac), platelet count (PLT), prothrombin time (PT), fibrinogen (Fib), troponin I (TnI), aspartate aminotransferase (AST), total bilirubin (TBIL), creatinine (Cr) and acute gastrointestinal injury (AGI) classification - as EHSS parameters. It is a 0-47 point system designed to reflect increasing severity of heat stroke. Low (EHSS< 20) and high scores (EHSS> 35) showed 100% survival and 100% mortality, respectively. We found that AUCEHSS > AUCSOFA > AUCAPACHE II. CONCLUSION: A total of 12 parameters - T, GCS, pH, Lac, PLT, PT, Fib, TnI, AST, TBIL, Cr and gastrointestinal AGI classification - are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients. As EHSS score increases, the mortality rate of EHS patients gradually increases.

Cooling therapy upregulates protein C activation in heat stressed rats: An experimental study.

Protein C (PC) pathway homeostasis is implicated in heat stress (HS). This study determines whether cooling could improve the PC pathway in HS. Fifty-six anesthetized rats were warmed to achieve HS (rectal temperature [Tr] 42°C). These rats were divided into seven groups: (a) control group:sacrifice immediately 15 min after HS; (b) HS+I:sacrifice immediately after 15 min ice-water treatment or (c) 3 hr after HS; (d) HS+C:sacrifice immediately after 15-min cold-water treatment or (e) 3 hr after HS; (f) HS: sacrifice immediately 15 min after HS or (g) 3 hr after HS. Plasma PC, activated protein C (APC), and soluble thrombomodulin (sTM) levels were tested at both time points. After cooling, Tr in the HS+I and HS+C groups significantly decreased, when compared with the HS group, and Tr was significantly lower in the HS+I group than in the HS+C group ( p < 0.05). Furthermore, sTM levels were highest in the HS group among the groups at both time points. Plasma PC and APC levels increased after HS. In the HS+I and HS+C groups, plasma APC levels and the APC/PC ratio significantly increased at both time points. The proportions were significantly higher in the HS+I group than in the HS+C group, and there was no significant increase in APC/PC ratio in the HS group. Cooling exerts an anticoagulant effect following HS by increasing APC levels. Ice-water blanket therapy is more effective than cold-water blanket therapy in increasing APC levels.

Response of regulatory T cells to classic heat stroke in mice.

Systemic inflammatory response syndrome (SIRS) is an important process associated with the pathogenesis of multiple organ failure resulting from heat stroke (HS). Alterations in the levels of circulating cytokines during the progression of SIRS have been well established. However, only a small number of studies have demonstrated the responses of lymphocytes during HS, and no studies have investigated immune-regulatory cells, such as regulatory T cells (Tregs). Tregs have been revealed to be important in numerous inflammation-associated diseases, and have exhibited promising therapeutic effects in both experimental and clinical trials. In the present study, the splenic Treg response in a classic HS mouse model was investigated, and the results demonstrated that total numbers of splenic Tregs were significantly decreased at 0, 24 and 72 h time intervals post-heat stress. Furthermore, the immunosuppressive capacity of splenic Tregs on cluster of differentiation (CD)4+T cell expansion was revealed to be suppressed following heat stress. In addition, HS was demonstrated to downregulate the expression levels of surface inhibitory molecules (CD39, CD73 and cytotoxic T-lymphocyte associated protein 4), as well as anti-inflammatory cytokines [interleukin (IL)-10, transforming growth factor-ß and IL-35], in Tregs. It was hypothesized that the aforementioned Treg responses may contribute to SIRS during HS. To the best of our knowledge, the present study is the first study to investigate the response of Tregs to HS, and the results demonstrated that there were significant alterations regarding to the total number, and function, of splenic Tregs, as well as the expression levels of inhibitory surface molecules and secretory cytokines. These results may highlight a novel mechanism underlying the pathogenesis of HS, as well as identify a potential therapeutic target for SIRS in patients suffering from HS.

Normal saline for intravenous fluid therapy in critically ill patients.

The efficacy and safety of normal saline (NS) for fluid therapy in critically ill patients remain controversy. In this review, we summarized the evidence of randomized controlled trials (RCTs) which compared NS with other solutions in critically ill patients. The results showed that when compared with 6% hydroxyethyl starch (HES), NS may reduce the onset of acute kidney injury (AKI). However, there is no significant different in mortality and incidence of AKI when compared with 10% HES, albumin and buffered crystalloid solution. Therefore, it is important to prescribe intravenous fluid for patients according to their individual condition.

A bibliometric analysis of exertional heat stroke research in Web of Science.

BACKGROUND: Exertional heat stroke is a fatal condition and remains a health problem. This paper evaluates the publication trend regarding exertional heat stroke research between 1996 and 2015 using a bibliometric method. METHOD: Articles regarding exertional heat stroke research published between 1996 and December 2015 were searched for in the SCI-EXPANDED database of Web of Science. The search results were analyzed with regard to publication year; publication quantity regarding countries/regions, and authors; citation frequency; and journal distribution. CiteSpace (v3.6) was used for a document co-citation visualization analysis. RESULTS: In total, 289 publications on heat stroke were located. After selection, 209 original articles conducted across 28 countries/regions and published in 83 journals were included in the analysis. The USA, Isreal, and France were the most common locations for exertional heat stroke studies. The CiteSpace visualization cluster analysis showed that exertional heat stroke-related mortality and protective measures were constant concerns of research. CONCLUSIONS: Research related to exertional heat stroke has been continuous concerned. USA is still the leading country in this field.

RETRACTED: Bosentan attenuates cardiac fibrosis in diabetic mice without affecting blood glucose.

At the request of the authors, 'Bosentan attenuates cardiac fibrosis in diabetic mice without affecting blood glucose' Journal of Renin-Angiotensin-Aldosterone System, published ahead of print August 15, 2011 as doi: 10.1177/1470320311417274 has been retracted. This is due to mistakes in the published data at Figure 3. For clarification: this problem came to the attention of Bo Yang only after publication in the journal. Bo Yang immediately brought it to the attention of the Journal.

Clinical trials comparing norepinephrine with vasopressin in patients with septic shock: a meta-analysis.

BACKGROUND: The effect of norepinephrine in patients with septic shock remains controversial. We conducted a meta-analysis to compare the mortality rates and benefits of norepinephrine and vasopressin. METHODS: PubMed, EMBASE, and the Cochrane Library database were searched from database inception to December 2013. We selected randomized controlled trials in adults with septic shock and compared norepinephrine with vasopressin. After assessing the heterogeneity of treatment effects across trials using the I (2) statistic, we used a fixed effects model (P ≥ 0.1) and expressed the results as risk ratios (RRs) for dichotomous outcomes or as standardized mean differences (SMDs) for continuous data with 95% confidence intervals (CIs). Meta-analysis was conducted using Review Manager 5.1 software. RESULTS: Seven trials (n = 2323) met the inclusion criteria. Overall, the mortality rate in these seven trials was 36.2% (840/2323). There was no difference in mortality following the use of norepinephrine or vasopressin (RR 1.07; 95%CI 0.97-1.20; P = 0.19). Compared to norepinephrine, vasopressin had no significant effect on heart rate (HR) (SMD 0.21; 95%CI -0.08-0.50; P = 0.15), mean arterial pressure (MAP) (SMD 0.15; 95%CI -0.15-0.44; P = 0.33), cardiac index (CI) (SMD -0.10; 95%CI -0.64-0.44; P = 0.73), systemic vascular resistance index (SVRI) (SMD 0.15; 95%CI -0.39-0.70; P = 0.58), oxygen delivery (DO2) (SMD -0.06; 95%CI -0.62-0.49; P = 0.82), oxygen consumption (VO2) (SMD 0.03; 95%CI -0.52-0.59; P = 0.91) or lactic acid (SMD 0.07; 95%CI -0.23-0.36; P = 0.66). No significant heterogeneity was found in these comparisons (P ≥ 0.1). CONCLUSIONS: There is not sufficient evidence to prove conclusively that norepinephrine is superior to vasopressin in terms of mortality and hemodynamics. The effects of norepinephrine and vasopressin on patients with septic shock require further study in large randomized controlled trials.

[Effectiveness of norepinephrine versus dopamine for septic shock: a meta analysis].

OBJECTIVE: To systematically evaluate the effect of norepinephrine and dopamine on patients with septic shock. METHODS: Randomized controlled trials (RCTs) about treatment of adults with septic shock with norepinephrine and dopamine were selected from PubMed, Embase, the Cochrane Library, CBM and CNKI databases. Meta analysis concerning the effect of norepinephrine and dopamine on hemodynamics and metabolism of patients with septic shock was conducted by using Review Manager 5.0 software. The results were expressed as risk ratio (RR) for dichotomous outcomes or standardized mean difference (SMD) for continuous data with 95% confidence intervals (95%CI). RESULTS: Eleven trials with 1718 cases were enrolled. Meta analysis showed that compared with dopamine, norepinephrine could decrease the mortality (RR=0.89, 95%CI 0.81-0.98, P=0.02). There were a decreased heart rate (SMD=-2.23, 95%CI -3.76 to -0.71, P=0.004), cardiac index (SMD=-0.71, 95%CI -1.07 to -0.35, P=0.0001) and an increased systemic vascular resistance index (SMD=1.39, 95%CI 0.54-2.23, P=0.001) were found in norepinephrine group compared with dopamine group. However, there were no significant differences on the effect of mean artery pressure (SMD=0.64, 95%CI -1.09-2.38, P=0.47), oxygen delivery (SMD=-0.54, 95%CI -1.50-0.42, P=0.27), oxygen consumption(SMD=-0.49, 95%CI -1.37-0.39, P=0.27) and lactic acid (SMD=-0.24, 95%CI -0.90-0.42, P=0.48) between these two vasopressors. CONCLUSIONS: Norepinephrine is associated with an improved hemodynamics and decreased mortality compared with dopamine in septic shock patients.

[Analysis of risk factors affecting prognosis of exertional heat stroke].

OBJECTIVE: To determine prognostic risk factors of exertional heat stroke (EHS). METHODS: Sixty-nine patients who met the case definition of EHS at ten military hospitals from June 2002 to August 2012 were enrolled in this retrospective study. The clinical data and prognosis was observed, including rhabdomyolysis (RM), disseminated intravascular coagulation (DIC), acute kidney injury (AKI), hepatosis, epilepsy, shock, arrhythmia, multiple organ dysfunction syndrome (MODS) and consciousness disorder. A logistic regression analysis was made to look for the significant risk factors, and its accuracy and reliability were tested and verified by statistical equation. RESULTS: There were 69 patients with EHS in the study, and 18 (26.09%) were dead. The independent prognostic factors were identified as DIC and AKI [DIC odds ratio (OR)=94.994, 95% confidence interval (95%CI) 3.837-2352.031, P=0.005; AKI OR=90.871, 95%CI 2.079-3971.995, P=0.019]. The mortality was 16.67% (3/18) when any one factor exist; the mortality was 93.75% (15/16) when two factors exist (sensibility was 83.33%; with specificity of 98.03%, positive predictive value of 93.75%, negative predictive value of 94.34%, and accuracy of 94.20%). CONCLUSIONS: Among all the clinical parameters, the major risk factors affecting prognosis of EHS included DIC and AKI. The mortality might go very high if both two risk factors exist.

[Clinical study of prognostic value of interleukin-6 in severe acute pancreatitis].

OBJECTIVE: To investigate the value of serum interleukin-6 (IL-6) level as a prognostic indicator in severe acute pancreatitis (SAP) patients. METHODS: Data of 62 cases of SAP admitted to Department of Critical Care Medicine from January 2006 to September 2012 were retrospectively analyzed. They were divided into two groups: non-survivor group (n=15) and survivor group (n=47). Serum levels of IL-6 at 24, 48, 72 hours after admission were compared between two groups. Correlation between IL-6 value and acute physiology and chronic health evaluation II (APACHE II) score and CT severity index (CTSI) at 48 hours were analyzed. The receiver-operating characteristic curve (ROC curve) was plotted at 48 hours to analyze the accuracy of IL-6 value as a prognostic indicator in the initial stage of SAP. RESULTS: The IL-6 values were elevated obviously followed by a lowering in non-survivor group. However, it continued to decrease gradually in survivor group. The IL-6 values of non-survivor group were significantly higher than those of survivor group at 48 hours and 72 hours after admission (545.5 ± 265.7 ng/L vs. 147.2 ± 107.0 ng/L, 243.0 ± 133.6 ng/L vs. 119.0 ± 69.5 ng/L, both P<0.01). IL-6 ROC had an area under curve (AUC) of 0.930 at 48 hours. In both groups, IL-6 values and APACHEII score showed a positive correlation (r=0.930, P=0.003; r=0.964, P=0.000), and also between IL-6 values and CTSI (r=0.915, P=0.000; r=0.921, P=0.005) at 48 hours. CONCLUSION: IL-6 can be a useful indicator of the prognosis in the initial stage of SAP (48 hours).

Acute removal of common sepsis mediators does not explain the effects of extracorporeal blood purification in experimental sepsis.

The effect of extracorporeal blood purification on clinical outcomes in sepsis is assumed to be related to modulation of plasma cytokine concentrations. To test this hypothesis directly, we treated rats that had a cecal ligation followed by puncture (a standard model of sepsis) with a modest dose of extracorporeal blood purification that did not result in acute changes in a panel of common cytokines associated with inflammation (TNF-α, IL-1ß, IL-6, and IL-10). Pre- and immediate post-treatment levels of these cytokines were unchanged compared to the sham therapy of extracorporeal circulation without blood purifying sorbent. The overall survival to 7 days, however, was significantly better in animals that received extracorporeal blood purification compared to those with a sham procedure. This panel of common plasma cytokines along with alanine aminotransferase and creatinine was significantly lower 72 h following extracorporeal blood purification compared to sham-treated rats. Thus, the effects of this procedure on organ function and survival do not appear to be due solely to immediate changes in the usual measured circulating cytokines. These results may have important implications for the design and conduct of future trials in sepsis including defining alternative targets for extracorporeal blood purification and other therapies.

[Experimental study of early blood purification in the treatment of post traumatic pulmonary fat embolism].

OBJECTIVE: To study the effect of early continuous blood purification (CBP) in the treatment of post-traumatic pulmonary fat embolism in dog. METHODS: Twelve healthy male mongrel dogs were randomly divided into two groups: group A received intramedullary reaming and bone cement injection of bilateral femurs (n=6), and group B received CBP simultaneously at the beginning of the same operation and continued until 120 minutes after the end of the operation (n=6). The changes in arterial blood gas and related cytokines were monitored at various time points. The animals were sacrificed 120 minutes after the operation, and the lungs were obtained for examination, and the amount of oil red O stained fat emboli was recorded. RESULTS: In group A, the mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP) and extravascular lung water (EVLW) increased after the manipulation in single femur, and these changes persisted after the manipulation on both femurs (all P<0.05). There was a decrease in pH and arterial partial pressure of oxygen (PaO2) and an increase in arterial partial pressure of carbon dioxide (PaCO2), tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta) and IL-6 after the operation on both femurs, showing significant differences compared with those of pre-operation period (all P<0.05). In group B, the hemodynamics, contents of cytokines and arterial blood gases were stable. Compared with those of group A, there was a significant decrease in the number of pulmonary fat emboli in group B (4.17+/-1.99 vs. 18.13+/-6.25, P<0.05). CONCLUSION: The therapy of CBP could decrease the level of the serum TNF-alpha, IL-1 beta , IL-6 and EVLW, MPAP, PCWP, which could ameliorate gas exchange and oxygenation of the lung. And it also could reduce the number of pulmonary fat emboli and decrease the incidence of pulmonary fat embolism caused by femoral intramedullary operation.

[Acute renal failure due to abdominal compartment syndrome].

OBJECTIVE: To observe the effect of intra-abdominal hypertension on renal function. METHODS: 30 intra-abdominal hypertension patients, 26 mals and 4 femals, age 42 +/- 17, were observed. Intra-abdominal pressure, mean arterial pressure, central venous pressure and serum creatinine were recorded and tested at the same time every day. RESULTS: When the intra-abdominal pressure increased, the urine output decreased (from 78 ml/h +/- 26 ml/h to 31 ml/h +/- 11 ml/h, P < 0.01), serum creatinine increased (from 110 mmol/L +/- 98 mmol/L to 224 mmol/L +/- 147 mmol/L, P < 0.01) with high central venous pressure (6.0 mm Hg +/- 2.1 mm Hg to 8.8 mm Hg +/- 2.5 mm Hg, 1 mm Hg = 0.133 kPa, P < 0.01) and high mean arterial pressure (from 79 mm Hg +/- 8 mm Hg to 86 mm Hg +/- 10 mm Hg, P < 0.01). There is a significant negative correlation between the intra-abdominal hypertension and urine output (r = -0.747, P < 0.01), and a significant positive correlation between the intra-abdominal hypertension and serum creatinine (r = 0.816, P < 0.01). During the ICU stay, 12 patients died, amoung which 8 died from multiple organ dysfunction due to septicemia and 4 died from abdominal hemorrhage. CONCLUSION: Intra-abdominal hypertension is correlated with lower urine output and increased blood creatinine significantly, and these results can be inversed when the intra-abdominal pressure decreases.