Serum ammonia is a strong prognostic factor for patients with acute-on-chronic liver failure

Hu, Chenxia; Huang, Kaizhou; Zhao, Lingfei; Zhang, Fen; Wang, Zhongwen; Li, Lanjuan

doi:10.1038/s41598-020-73603-1

Cited by 35 publications

(29 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The serum ammonia level has widely been used as a biomarker for the diagnosis and treatment of liver failure, and for identi cation of hepatic associated with hyperammonemia. (34) Treating high serum ammonia levels effectively restores consciousness, attenuates the incidence of cerebral edema, and improves overall morbidity and mortality. However, the clinical signi cance of NHH as a prognostic indicator has long been neglected.…”

Section: Discussionmentioning

confidence: 99%

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

Li¹,

Yao²,

Li³

et al. 2021

Preprint

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Li¹,

Yao²,

Li³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…This was supported by Hu et al . [ 36 ] from China who measured ammonia levels in patients with acute-on-chronic liver failure and predicted raised ammonia levels to be an important prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

Differentiation of hepatic encephalopathy from delirium tremens

Devabhaktuni

Patkar

Pooja

et al. 2021

Industrial Psychiatry Journal

View full text Add to dashboard Cite

Hepatic encephalopathy (HE) is an important and potentially life threatening complication in alcoholic patients with decompensated liver function that develop even as they continue drinking. Delirium tremens, on the other hand, is an acute condition resulting from alcohol abstinence in a person dependent on alcohol, making it a life threatening diagnosis that requires intensive care and successful management of the withdrawal. Often in medical wards, these two conditions are mistaken and so is the management plan confused with each other. Making the right diagnosis early on during the hospital course is extremely important in these critical conditions so as to make an appropriate schedule for treatment and a better outcome for the same. A case series of patients who presented with a diagnostic dilemma is reported. Clinical examinations, diagnostic tools to measure the levels of ammonia and liver function tests and hemogram, West Haven criteria and Child–Pugh grading, and clinical scales of these patients are reported. Increased levels of ammonia were present in all the cases. The subtle similarities in the presentation of the two conditions often make it confusing for the clinician to distinguish between them. Using a simple test of measuring ammonia levels in the blood helps in such situations. The detection of raised levels of ammonia in cases of chronic liver disease helps in not just the diagnosis but also is an important prognostic indicator for development of HE.

show abstract

“…Hu et al found that hyperammoniemia was significant in 28-day mortality in acute and chronic liver failure (19).…”

Section: Discussionmentioning

confidence: 99%

Retrospective Evaluation of the Effect of Ammonia Levels on Mortality in Patients With Hepatic Encephalopathy Applying to the Emergency Department

GÜNGÖR

Erdem²

2021

Kırıkkale Üniversitesi Tıp Fakültesi Dergisi

View full text Add to dashboard Cite

Objective: Hepatic encephalopathy is a cognitive, motor and behavioral disorder caused by the accumulation of liver metabolism products accompanying hepatic failure. The clinical picture of hepatic encephalopathy appears with the accumulation of metabolites such as ammonia and gamma aminobutyric acid. In our study, we aimed to investigate the effect of blood ammonia levels on mortality in patients diagnosed with hepatic encephalopathy. Material and Methods: The records of patients who were admitted to the emergency department of our hospital with impaired consciousness, known chronic liver disease, and whose ammonia levels were studied between January 01 2015 and December 31 2018 were retrospectively analyzed. Liver function tests and coagulation tests of the patients were recorded. The patients were divided into two groups as with and without hepatic encephalopathy. The groups were divided into stages according to the West Haven classification. Liver function tests and coagulation tests of the two groups were compared according to ammonia level, disease stage and mortality.

show abstract

Serum ammonia is a strong prognostic factor for patients with acute-on-chronic liver failure

Cited by 35 publications

References 37 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

Differentiation of hepatic encephalopathy from delirium tremens

Retrospective Evaluation of the Effect of Ammonia Levels on Mortality in Patients With Hepatic Encephalopathy Applying to the Emergency Department

Contact Info

Product

Resources

About