Hyperammonemia in ICU patients: A frequent finding associated with high mortality

Prado, Fabrizio Almeida; Delfino, Vinícius Daher Alvares; Grion, Cíntia Magalhães Carvalho; Oliveira, João

doi:10.1016/j.jhep.2015.01.009

Cited by 22 publications

(27 citation statements)

References 12 publications

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“…In this study, we found the incidence of hyperammonemia in critical care patients without liver disease to be 42.2%. A recent prospective observational study with one hundred patients found, after excluding those patients with acute or chronic liver disease, hyperammonemia was observed in 40% of patients on their first day in the ICU and 60% by their third day in the ICU (5) A retrospective observational cohort study conducted on critically ill patients admitted to six ICUs found the lowest incidence of NHH in the literature at 8.6%, (4) while the highest recorded incidence was 73% (5) In previous studies, the largest sample size of non-hepatic hyperammonemia patients was still relatively small at 167 patients, (4) while the smallest sample size was 78 patients (18).…”

Section: Discussionmentioning

confidence: 99%

“…Elevated blood ammonia levels without a history of liver disease is defined as non-hepatic hyperammonemia (NHH). NHH can be quite common in critically ill patients (up to 73% in a recent study) (5). NHH can occur in patients with a variety of serious conditions, such as intracranial hypertension (6) or congestive heart failure, malnutrition, infectious enterocolitis, or lung transplantation (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Role of Ammonia in Critical Care Patients Without Known Hepatic Disease

et al. 2020

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Background and Aims: Hyperammonemia usually develops because of hepatic disease, but it may occur in patients with non-hepatic hyperammonemia (NHH). But, studies on the prognosis and possible risk factors of this disorder are lacking. The aim of this study was to find possible prognostic and risk factors for NHH in critically ill patients. Methods: Data were extracted from MIMIC III Database. Survival was analyzed by the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify prognostic factors. Results: Valproic acid, carbamazepine, corticosteroids, recent orthopedic surgery, epilepsy, disorders of urea cycle metabolism, and obesity were found to be risk factors for NHH. Patients in the hyperammonemia group had a higher 30 day mortality than those in the non-hyperammonemia group. After final regression analysis, ammonia was found to be independent predictors of mortality. Conclusion: Ammonia was an independent prognostic predictor of 30 day mortality for critical care patients without liver disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic Role of Ammonia in Critical Care Patients Without Known Hepatic Disease

et al. 2020

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“…Non-cirrhotic hyperammonaemic encephalopathy (NCHAE) is less common; however, it is increasingly being recognised as a cause of encephalopathy. Hyperammonaemia in patients in the intensive care unit is associated with high mortality, and hyperammonaemic encephalopathy can progress from confusion to coma with cerebral oedema, brain stem herniation and death 2. We present a case highlighting that hyperammonaemia in NCHAE may be multifactorial in origin.…”

Section: Introductionmentioning

confidence: 91%

Multifactorial non-cirrhotic hyperammonaemic encephalopathy

2018

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A 51-year-old female presented with acute confusion associated with a non-specific headache and lethargy. The patient's history included bipolar disorder on valproate and recent travel to northern Vietnam. The patient was subsequently found to have hyperammonaemia as well as a urinary tract infection and bacteraemia with The patient was presumed to have a multifactorial non-cirrhotic hyperammonaemic encephalopathy due to a combination of a urinary tract infection and bacteraemia with, a urease-producing bacteria, and also valproate use, a medication known to interfere with ammonia elimination. The patient's treatment included supportive care, ceasing valproate, empiric then rationalised antibiotics, N-acetylcysteine and L-carnitine. We present a case of non-cirrhotic hyperammonaemic encephalopathy and explain why it is multifactorial in origin.

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“…Most patients with non-hepatic hyperammonemia present with confusion and coma [23,24]. Nonhepatic hyperammonemia in intensive care unit (ICU) patients has especially high morbidity and mortality [25,26]. There are several reviews and case reports on hyperammonemia in non-hepatic disease and ICU patients, but large observational studies on non-hepatic hyperammonemia are limited [24,26].…”

Section: Introductionmentioning

confidence: 99%

“…Nonhepatic hyperammonemia in intensive care unit (ICU) patients has especially high morbidity and mortality [25,26]. There are several reviews and case reports on hyperammonemia in non-hepatic disease and ICU patients, but large observational studies on non-hepatic hyperammonemia are limited [24,26]. Fabrizio et al reported that ammonia levels affect the mortality rates of ICU patients with non-hepatic disease and were correlated with mortality by univariate analysis using the chi-square test in 100 patients with nonhyperammonemia [26].…”

Section: Introductionmentioning

confidence: 99%

Impact of Non-Hepatic Hyperammonemia on Mortality in Intensive Care Unit Patients: A Retrospective Cohort Study

Kim

Jeon

Lee

et al. 2020

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Background: The effect of hyperammonemia on the mortality in patients with liver cirrhosis is well documented. However, little is known about the impact of hyperammonemia on mortality in intensive care unit patients without hepatic disease. We aimed to investigate factors associated with non-hepatic hyperammonemia in intensive care unit patients and evaluate the factors related to 90-day mortality. Methods: Between February 2016 and February 2020, 972 cases in 948 intensive care unit patients without hepatic disease were retrospectively enrolled and classified as hyperammonemia grades 0 (≤80 µg/dL; n=585 (60.2%)), 1 (≤160 µg/dL; n=291 (29.9%)), 2 (≤240 µg/dL; n=55 (5.7%)), and 3 (>240 µg/dL; n=41 (4.2%)). Factors associated with hyperammonemia and 90-day mortality were evaluated by multivariate logistic regression analysis and Cox regression analysis, respectively. Kaplan-Meier survival curves for 90-day mortality were constructed.Results: The independent risk factors for hyperammonemia were male sex (odds ratio, 1.517), age (0.984 per year), acute brain failure (2.467), acute kidney injury (1.437), prothrombin time-international normalized ratio (2.272 per unit), and albumin (0.694 per g/dL). The 90-day mortality rate in the entire cohort was 24.3% and gradually increased with increasing hyperammonemia grade at admission (17.9%, 28.2%, 43.6%, and 61.0% in patients with grades 0, 1, 2, and 3, respectively). Additionally, non-hepatic hyperammonemia was an independent predictor of 90-day mortality in intensive care unit patients. Conclusions: Non-hepatic hyperammonemia is common (39.8%) and associated with 90-day mortality in intensive care unit patients. Therefore, clinicians must examine serum ammonia levels in patients before admission to intensive care unit.

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Hyperammonemia in ICU patients: A frequent finding associated with high mortality

Abstract: Please cite this article as: Prado, F.A., Delfino, V.D.A., Grion, C.M.C., de Oliveira, J.A., Hyperammonemia in ICU Patients: A Frequent Finding Associated with High Mortality, Journal of Hepatology (2015), doi: http://dx.

Cited by 22 publications

References 12 publications

Prognostic Role of Ammonia in Critical Care Patients Without Known Hepatic Disease

Prognostic Role of Ammonia in Critical Care Patients Without Known Hepatic Disease

Multifactorial non-cirrhotic hyperammonaemic encephalopathy

Impact of Non-Hepatic Hyperammonemia on Mortality in Intensive Care Unit Patients: A Retrospective Cohort Study

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