Hyperammonemic encephalopathy with septic shock caused by obstructive urinary tract infection

Kida, Yoshihisa; Oiwa, Takehiro; Deguchi, Ryusuke

doi:10.1016/j.idcr.2018.e00436

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Infection by bacteria which rely on urease to hydrolyze urea to carbon dioxide and ammonia, as well as pneumonia, fever, and other stressors may ultimately result in NHH. ( 25 (30,31) In the present research, we examined whether there could be differences in the different prognosis between distinct types of diseases (e.g., Sepsis, Kidney failure), and no signi cant differences were identi ed, consistent with previously reported results in severity of hyperammonemia. (17) This may be attributed to the diverse and complicated etiology of NHH, which indicating the prognosis.…”

Section: Discussionsupporting

confidence: 78%

Prognostic Value of Serum Ammonia in Critical Patients with Non-Hepatic Disease : A Prospective, Observational, Multicenter Study

Li¹,

Yao²,

Li³

et al. 2021

Preprint

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Background: Non-hepatic hyperammonemia can damage the central nervous system (CNS) and possible prognostic factors are lacking. This study aimed to investigate the prognostic and risk factors for patients admitted to the intensive care unit (ICU).Methods: This prospective, observational, multicenter study was conducted between November and December 2019 at 11 ICUs in the Chinese Heilongjiang province. Changes in blood ammonia level during and after ICU admission were continuously monitored, expressed as the high-level (H-), mean-level (M-), and initial-level (I-) of ammonia. The risk factors of poor prognosis were investigated by conducting univariate and multivariate logistic regression analyses. Receiver operating characteristic curve (ROC) analysis was conducted to compare predictive ability of APACHE-II score, lactic acid, TBil, M-ammonia.Results: A total of 1060 patients were included in this study, of which 707 (67%) had a favorable prognosis and 353 (33%) had a poor prognosis. As shown by univariate models, a poor prognosis was associated with elevated serum levels of lactic acid, TBil, and ammonia (P<0.05), and pathologic scores from three assessments: APACHE-II, GCS, and SOFA. Multivariate analysis revealed that circulating mean ammonia levels in ICU patients were independently associated with a poor prognosis (OR=1.73, 95% CI: 1.07-2.80, P=0.02). However, the APACHE-II score (AUC: 0.714, sensitivity: 0.86, specificity: 0.68, P <0.001) remained the most predictive factor for patient prognosis by ROC analysis.Conclusions: Elevated serum levels of ammonia in the blood were independently prognostic for ICU patients without liver disease.Trial registration: ChiCTR1900026632. Registered 16 October 2014.

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Section: Discussionsupporting

confidence: 78%

Prognostic Value of Serum Ammonia in Critical Patients with Non-Hepatic Disease : A Prospective, Observational, Multicenter Study

Li¹,

Yao²,

Li³

et al. 2021

Preprint

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show abstract

“…It may also be involved in in the pathogenesis of septic shock via inflammatory responses and impaired tissue perfusion. [ 30 , 31 ] In the present research, we examined whether there could be differences in the different prognoses between distinct types of diseases ( e.g ., sepsis, kidney failure), and no significant differences were identified, consistent with previously reported results on the severity of hyperammonemia. [ 17 ] This may be attributed to the diverse and complicated etiology of NHH, which indicates the prognosis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of serum ammonia in critical patients with non-hepatic disease: A prospective, observational, multicenter study

Yao

et al. 2022

Journal of Translational Internal Medicine

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Background and Objectives Non-hepatic hyperammonemia can damage the central nervous system (CNS), and possible prognostic factors are lacking. This study aimed to investigate the prognostic and risk factors for patients admitted to the intensive care unit (ICU). Materials and Methods This prospective, observational, multicenter study was conducted between November and December 2019 at 11 ICUs in the Chinese Heilongjiang province. Changes in blood ammonia level during and after ICU admission were continuously monitored and expressed as the high level (H-), mean level (M-), and initial level (I-) of ammonia. The risk factors of poor prognosis were investigated by conducting univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive ability of Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE-II) score, lactic acid, total bilirubin (TBil), and M-ammonia. Results A total of 1060 patients were included in this study, of which 707 (67%) had a favorable prognosis and 353 (33%) had a poor prognosis. As shown by univariate models, a poor prognosis was associated with elevated serum levels of lactic acid, TBil, and ammonia (P < 0.05) and pathologic scores from three assessments: APACHE-II, Glasgow Coma Scale (GCS), and Sequential Organ Failure Assessment (SOFA). Multivariate analysis revealed that circulating mean ammonia levels in ICU patients were independently associated with a poor prognosis (odds ratio [OR] = 1.73, 95% confidence interval [CI]: 1.07–2.80, P = 0.02). However, the APACHE-II score (area under the curve [AUC]: 0.714, sensitivity: 0.86, specificity: 0.68, P < 0.001) remained the most predictive factor for patient prognosis by ROC analysis. Conclusion Elevated serum levels of ammonia in the blood were independently prognostic for ICU patients without liver disease.

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Hyperammonaemia: review of the pathophysiology, aetiology and investigation

Meier,

Burns,

Manolikos

et al. 2024

Pathology

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Hyperammonemic encephalopathy with septic shock caused by obstructive urinary tract infection

Cited by 3 publications

References 8 publications

Prognostic Value of Serum Ammonia in Critical Patients with Non-Hepatic Disease : A Prospective, Observational, Multicenter Study

Prognostic Value of Serum Ammonia in Critical Patients with Non-Hepatic Disease : A Prospective, Observational, Multicenter Study

Prognostic value of serum ammonia in critical patients with non-hepatic disease: A prospective, observational, multicenter study

Hyperammonaemia: review of the pathophysiology, aetiology and investigation

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