Ammonia Level and Mortality in Acute Liver Failure: A Single-Center Experience

Niranjan-Azadi, Ashwini; Araz, Filiz; Patel, Yuval A.; Alachkar, Nada; Alqahtani, Saleh A.; Cameron, Andrew M.; Stevens, Robert; Gürakar, Ahmet

doi:10.12659/aot.898901

Cited by 21 publications

(18 citation statements)

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“…(6) ve Niranshan-Azadi ve ark. (7) yaptığı çalışmalarda sırasıyla yaş ortalaması 25 ve 42 olduğu saptanmıştır. Bhatia ve ark.…”

Section: Gereç Ve Yöntemunclassified

“…Niranshan-Azadi ve ark. (7) tarafından yapılan çalışmada ise yüksek kan amonyak düzeylerini yüksek mortalite oranlarıyla korele olduğu gösterilmiştir. Çalışmamızdaki 6 ay içinde eksitus olan hastaların ortalama amonyak düzeyleri mortalite gelişmeyen hastaların kan amonyak değerlerinden yüksek olmasına rağmen istatistiksel olarak anlamlı fark bulunmamıştır (197.54±119.18, 188.88±105.15, sırasıyla).…”

Section: Gereç Ve Yöntemunclassified

“…(6) yaptığı çalışmada bu oran %36, Niranshan-Azadi ve ark. (7) yaptığı çalışmada ise oranın %58 olması kadın ve erkek popülasyonu arasında belirgin fark görülmediğini göstermektedir.…”

Section: Introductionunclassified

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Prognostic Value of Increased Blood Ammonia Levels in Emergency Department

Tapkan¹,

Kalafat²,

Doğan³

et al. 2019

IKSST

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%42'si (n=37) kadın, %58'i (n=51) erkek idi. Ortalama yaş 61. 42±15.69 yıl idi. Olguların %70.5'inde (n=62) siroz, %23.9'unda (n=21) karaciğerde malignite ve %26.1'inde (n=23) diğer kronik hastalıklar olduğu tespit edildi. Hastaların ortalama kan şekeri düzeyi 153,84±118.44 mg/dl, ortalama amonyak (NH3) düzeyi 194.19±113.42 idi. Hastaların %37.5'i (n=33) taburcu, %54.5'i (n=48) yatış ve %8'inin (n=7) öldüğü tespit edildi. Hastaların ortalama kan amonyak değerini 194,19±113,42 olarak saptadık, %61.4'ünün (n=54) altı ay içinde mortalite ile sonuçlanırken, %38.6'sında (n=34) altı ay içinde mortalite gelişmediğini gözlemledik. Sonuç: Acil seviste artmış kan amonyak düzeyinin primer ya da metastatik karaciğer malignitesi olan hastalar dışında prognostik değerliliğinin olmadığını düşünmekteyiz.ABSTRACT Introduction: An increase in blood ammonia levels, is a condition that occurs in patients with impaired liver function. In this study we aimed to investigate whether there is a relationship between increased ammonia levels and prognosis in these patients. Methods: In this study, patients with incresed ammonia level who applied emergency clinic of Health Science University Kanuni Sultan Suleyman Research and Training Hospital between 01.01.2016 and 01.01.2017 researched retrospectively. NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA) program was used for statistical analysis. Significance was assessed at p<0.05. Results: 88 patients were scanned in this study, %42 (n=37) of them were female and %58(n=51) of them were male. The mean age was determined as 61.42±15.69. Cirrhosis was observed in 70.5% (n=62) of the cases, malignancy findings in the liver in 23.9% (n=21) and other chronic diseases in 26.1% (n=23) were observed. The mean blood sugar level was 153,84±118.44 mg/dl and the mean blood ammonia level of these cases was 194.19±113.42. It was observed that 37.5% (n=33) of the cases were discharged, 54.5% (n=48) of them was hospitalized and 8% (n=7) of them did die. The mean blood ammonia value of the patients was found to be 194.19 ± 113.42, 61.4% (n=54) resulted in mortality within six months, and 38.6% (n 34) had no mortality within six months. Conclusion: We think that increased blood ammonia levels can not be use as a prognostic value in emergency department, except patients with primary or metastatic liver malignancies.

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“…(6) ve Niranshan-Azadi ve ark. (7) yaptığı çalışmalarda sırasıyla yaş ortalaması 25 ve 42 olduğu saptanmıştır. Bhatia ve ark.…”

Section: Gereç Ve Yöntemunclassified

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Prognostic Value of Increased Blood Ammonia Levels in Emergency Department

Tapkan¹,

Kalafat²,

Doğan³

et al. 2019

IKSST

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“…Hyperammonemia is a life-threatening metabolic condition characterized by elevated levels of ammonia and as be known for a long time to be a common event in acute and chronic liver injury [1]. Indeed, admission ammonia level was shown to be a predictive factor of mortality in acute liver patients [2] whereas hyperammonemia was previously associated with increasing Child-Pugh grade of liver cirrhosis [3]. In agreement with these line of evidence, several ammonia-lowering therapies have been associated with improvements in acute liver failure [4] and chronic liver disease outcomes, both in experimental models [5, 6] and in the clinical setting [7–9].…”

Section: Introductionmentioning

confidence: 99%

A morphological method for ammonia detection in liver

et al. 2017

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Hyperammonemia is a metabolic condition characterized by elevated levels of ammonia and a common event in acute liver injury/failure and chronic liver disease. Even though hepatic ammonia levels are potential predictive factors of patient outcome, easy and inexpensive methods aiming at the detection of liver ammonia accumulation in the clinical setting remain unavailable. Thus, herein we have developed a morphological method, based on the utilization of Nessler´s reagent, to accurately and precisely detect the accumulation of ammonia in biological tissue. We have validated our method against a commercially available kit in mouse tissue samples and, by using this modified method, we have confirmed the hepatic accumulation of ammonia in clinical and animal models of acute and chronic advanced liver injury as well as in the progression of fatty liver disease. Overall, we propose a morphological method for ammonia detection in liver that correlates well with the degree of liver disease severity and therefore can be potentially used to predict patient outcome.

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“…No single method can effectively identify patients at risk for cerebral edema. A high ammonia level should raise suspicion but on its own is not sufficient . Monitoring of ALF patients for the development of cerebral edema and elevated ICP is fundamental to prevent death and improve outcomes.…”

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confidence: 99%

Neurological Monitoring in Acute Liver Failure

et al. 2019

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A cute liver failure (ALF) results in diffuse cerebral dysfunction ranging from minor hepatic encephalopathy (HE) to coma, and disproportionately affects young, healthy adults. In these patients, neurological morbidity and mortality result from the development of cerebral edema and elevated intracranial pressure (ICP). (1) HE is potentially reversible with timely liver transplantation or spontaneous improvement in liver dysfunction, and prompt treatment of these patients can prevent death and improve outcomes. No single method can effectively identify patients at risk for cerebral edema. A high ammonia level should raise suspicion but on its own is not sufficient. (2) Monitoring of ALF patients for the development of cerebral edema and elevated ICP is fundamental to prevent death and improve outcomes. This review discusses the benefits and drawbacks of monitoring modalities and proposes a monitoring protocol.All patients with ALF should be closely monitored regardless of HE grade as patients can rapidly deteriorate. Stupor or coma can be due to severe HE, seizures, ischemic or hemorrhagic stroke, or impending cerebral herniation (1) ; and these etiologies cannot be distinguished without more advanced neuromonitoring. Elevated ICP occurs in up to 75%-90% of patients with high-grade HE (3) and is more common in patients with higher ammonia levels, renal failure, and a more rapid course. However, these are not absolutes, and without objective methods of neuromonitoring, patients may decompensate and develop elevated ICP without being noticed. Elevations in ICP can cause ischemic injury to the brain by lowering cerebral perfusion pressure and can lead to direct injury by herniation.A recent survey of liver transplantation sites revealed significant variabilities in monitoring ALF patients, reflecting the lack of evidence-based recommendations for neurological monitoring. (4) Further, significant fluid shifts can occur intraoperatively and postoperatively, which may precipitate elevations in ICP; and no guidelines exist for intraoperative neuromonitoring.(3) In one study of 22 patients with ALF who had ICP monitor placement, 82 episodes of elevated ICP occurred in 21 patients, with 5% occurring during the operative course and 20% occurring posttransplant.(3) Appropriate monitoring may prompt changes in standard operating room procedures such as positioning in a reverse Trendelenburg position, administration of hyperosmolar therapies, and, in rare cases, induction of hypothermia. Neurological ExamsThe single most important monitoring modality in the low-grade HE patient is the neurological exam. HE usually begins with mild encephalopathy and frontal dysfunction. (1) As encephalopathy progresses, personality changes become more pronounced and level of consciousness decreases.Signs of elevated ICP include worsening level of consciousness, worsening pupillary light reflexes, and loss of

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Ammonia Level and Mortality in Acute Liver Failure: A Single-Center Experience

Cited by 21 publications

References 0 publications

Prognostic Value of Increased Blood Ammonia Levels in Emergency Department

Prognostic Value of Increased Blood Ammonia Levels in Emergency Department

A morphological method for ammonia detection in liver

Neurological Monitoring in Acute Liver Failure

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