Elevated Intra‑Abdominal Pressure as a Prognostic Marker of Enteral Nutrition Intolerance and Adverse Outcomes in Neurocritical Care: A Retrospective Cohort Study

Objective: This study investigated the association between intra-abdominal pressure (IAP), enteral nutrition tolerance, and the clinical outcomes. Methods: In this retrospective cohort study, 120 patients admitted to a neurological critical care unit between 2021 and 2024 were evaluated. Only the patients receiving enteral nutrition for five or more days were included. IAP was measured every six hours via bladder catheterization. Data regarding gastrointestinal complications, nutritional adequacy (volume ratio), and hospital outcomes were analyzed using multivariate logistic regression and random-effects modeling. Results: Elevated intra-abdominal pressure (exceeding 14 mmHg) was present in 92% of the cohort. Patients with gastrointestinal complications 54 (45%) exhibited significantly higher intra-abdominal pressure (16.1 vs. 15.45 mmHg; p = 0.0212), significantly longer stays in the neurocritical care unit (p = 0.0002) and longer total hospitalizations (p = 0.0002) compared to those without complications 66 (55%). Diarrhea (33%) and constipation (31%) were the most frequent complications. Multivariate analysis identified intra-abdominal pressure as an independent predictor of prolonged intensive care stay (RR 2.209), extended total hospitalization (RR 2.203), and mortality (RR 2.062). Furthermore, high intra-abdominal pressure was significantly associated with a failure to achieve ninety percent of nutritional goals (p < 0.0001). Conclusions: Intra-abdominal pressure is a reliable indicator of enteral nutrition intolerance and systemic deterioration in neurocritical care. Routine monitoring of abdominal pressure should be integrated into clinical practice to enhance risk stratification and optimize nutritional delivery in patients with acute neurological injury.