Multifactorial non-cirrhotic hyperammonaemic encephalopathy

Triplett, Katherine E; Murray, Ronan J.; Anstey, Matthew

doi:10.1136/bcr-2017-223245

Cited by 9 publications

(7 citation statements)

References 14 publications

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“…Previous research found Klebisiella species and Pseudomonas aeruginosa can cause an increase in ammonia production. It causes non-hepatic hyperammonemia encephalopathy (16,35). They may be attributed to produce urease.…”

Section: Discussionmentioning

confidence: 99%

“…There have been a few small sample size studies and case reports of NHH (15). NHH has been associated with organ failure, prolonged fasting, and urinary tract infections (16), but studies investigating the prognostic or risk factors on this topic are scarce. The objective of this retrospective cohort study was to determine what risk factors were associated with the development of NHH after hospital admission in critical care patients.…”

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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“…The patient presented to the same hospital and was treated predominantly by the same intensive care specialists each time. Through the patient perspective that she had written as part of the BMJ case report related to her first admission,3 we had unique insight into the issues that she had in recovering from her first critical illness. Based on this, we were able to make the informed and deliberate decision to reinstitute her usual antipsychotics and antidepressants early in her admission to hopefully alleviate some of the psychiatric issues that she had post her first critical illness.…”

Section: Discussionmentioning

confidence: 99%

“…total daily dose of 250 mg) and migraines on amitriptyline 50 mg nocte. She also had an ICU admission approximately 2 years prior, previously reported,3 for non-cirrhotic hyperammonaemic encephalopathy thought to be due to a combination of a Klebsiella pneumoniae urinary tract infection with bacteraemia and sodium valproate therapy.…”

Section: Case Presentationmentioning

confidence: 98%

Psychiatric symptoms post intensive care unit admission

2019

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A 53-year-old woman was admitted to a tertiary intensive care unit (ICU) with acute respiratory distress syndrome secondary to severe community-acquired pneumonia that necessitated maximum supportive care with venovenous extracorporeal membrane oxygenation. Her medical history included bipolar disorder on quetiapine and sertraline, as well as a previous ICU admission, approximately 2 years prior, for non-cirrhotic hyperammonaemic encephalopathy that was complicated by prolonged post discharge anxiety and post-traumatic stress disorder-like symptoms, consistent with post-intensive-care syndrome. Here, we present a case, and explore the outcomes for a patient who had two separate admissions with life-threatening illnesses, but had distinct differences in the psychological outcomes following each illness.

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“…Hyperammonemia has occured as a consequence of the reduction in the detoxification capabilities of the liver in the setting of liver failure as well as with increased intestinal production of ammonia[ 1 ]. However, several other conditions that determine an imbalance between the production and the clearance of ammonia such as infections with urease-producing bacteria, high-protein diet, malignancy, sarcopenia, renal failure, gastrointestinal (GI) bleeding, gastric bypass, and organ transplantation can also determine high ammonia levels[ 2 ] and sometimes lead to non-cirrhotic encephalopathy[ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Role of ammonia in predicting the outcome of patients with acute-on-chronic liver failure

Chiriac¹,

Stanciu²,

Cojocariu³

et al. 2021

WJCC

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BACKGROUND High venous ammonia (VA) values have been proven to be a part of the mechanism of hepatic encephalopathy in patients with liver cirrhosis (LC) as well as acute hepatitis. Moreover, VA has been associated with poor prognosis and high mortality in these clinical settings. However, the role of ammonia in acute-on-chronic liver failure (ACLF) has not yet been clearly established. AIM To assess the role of VA in predicting the outcome of cirrhotic patients with ACLF in a tertiary care center. METHODS We performed a retrospective observational study including consecutive patients with LC hospitalized for acute non-elective indications such as ascites, hepatic encephalopathy (HE), upper gastrointestinal bleeding, or bacterial infections that fulfilled the Asian Pacific Association for the Study of the Liver (APASL) criteria for ACLF. The study was conducted in “St. Spiridon” University Hospital, Iasi, Romania, a tertiary care center, between January 2017 and January 2019. The APASL ACLF Research Consortium (AARC) score was calculated and ACLF grade was established accordingly. West-haven classification was used for HE. Statistical analysis was performed using IBM SPSS version 22.0. RESULTS Four hundred and forty-six patients were included, aged 59 (50-65) years, 57.4% men. Child-Pugh, model for end-stage liver disease (MELD) and AARC scores were 11 (10-12), 19.13 ± 6.79, and 7 (6-8), respectively. 66.4% had ACLF grade I, 31.2% ACLF grade II, and 2.5% ACLF grade III. HE was diagnosed in 83.9%, 34% grade I, 37.2% grade II, 23.5% grade III, and 5.3% grade IV. Overall mortality was 7.8%. VA was 103 (78-148) μmol/L. Receiver operating characteristic analysis showed good accuracy for the prediction of in-hospital mortality for the AARC score [Area under the curve (AUC) = 0.886], MELD score (AUC = 0.816), VA (AUC = 0.812) and a fair accuracy for the Child-Pugh score (AUC = 0.799). Subsequently, a cut-off value for the prediction of mortality was identified for VA (152.5 μmol/L, sensitivity = 0.706, 1-specificity = 0.190). Univariate analysis found acute kidney injury, severe HE (grade III or IV), VA ≥ 152.5 μmol/L, MELD score ≥ 22.5, Child-Pugh score ≥ 12.5, and AARC score ≥ 8.5 to be associated with in-hospital mortality. Multivariate analysis identified AARC score ≥ 8.5 and venous ammonia ≥ 152 μmol/L to be independent predictors of in-hospital mortality. CONCLUSION VA could be used as an inexpensive predictor of in-hospital mortality in patients with ACLF. Patients with both ACLF and VA > 152.5 μmol/L have a high risk for a poor outcome.

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Multifactorial non-cirrhotic hyperammonaemic encephalopathy

Cited by 9 publications

References 14 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

Psychiatric symptoms post intensive care unit admission

Role of ammonia in predicting the outcome of patients with acute-on-chronic liver failure

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