Background: Intra-abdominal pressure (IAP) may increase in acute decompensated heart failure (ADHF) due to fluid accumulation in the splanchnic system, contributing to renal venous congestion and impaired diuresis. This study aimed to evaluate the predictive value of IAP for early diuretic response in patients with ADHF.

Methods: This prospective, single-center study included 83 patients (mean age 71.6 ± 13.6 years, 58.9% female) admitted to the intensive care unit for ADHF. Patients requiring renal replacement therapy or in refractory shock were excluded. Guideline-directed medical therapy including intravenous loop diuretics was administered. The IAP was measured intravesically via Foley catheter and pressure transducer before treatment initiation. Elevated IAP was defined as >8 mm Hg. Abdominal perfusion pressure (APP) was calculated as mean arterial pressure minus IAP.

Results: Patients were divided into elevated IAP (n = 44) and normal IAP (n = 39) groups. Baseline demographics were comparable. The APP was significantly lower in the elevated IAP group (65.3 vs. 74 mm Hg; P = .008). The IAP showed a moderate negative correlation with 24-hour and 48-hour urine output (R2 = 0.192 and 0.131). Each 1 mm Hg increase in IAP was associated with a 213 mL and 310 mL decrease in urine output at 24 and 48 hours, respectively.

Conclusion: Intravesical IAP measurement may serve as a practical tool to predict short-term diuretic response in ADHF. Elevated IAP and reduced APP could help identify patients requiring intensified decongestive strategies.