Ammonia - an old friend with a new area of application

Gairing, Simon Johannes; Kaps, Leonard; Schleicher, Eva Maria; Galle, Peter R.; Labenz, Christian

doi:10.1016/j.jhep.2022.08.007

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…Interestingly, ammonia levels reported by Gairing et al. 29 were similar to ours and only a minority of individuals had ammonia levels above the ULN (13% vs. 19% in our cohort).…”

Section: Discussionsupporting

confidence: 89%

Impact of ammonia levels on outcome in clinically stable outpatients with advanced chronic liver disease

Balcar¹,

Krawanja²,

Scheiner³

et al. 2023

JHEP Reports

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“…Interestingly, ammonia levels reported by Gairing et al. 29 were similar to ours and only a minority of individuals had ammonia levels above the ULN (13% vs. 19% in our cohort).…”

Section: Discussionsupporting

confidence: 89%

Impact of ammonia levels on outcome in clinically stable outpatients with advanced chronic liver disease

Balcar¹,

Krawanja²,

Scheiner³

et al. 2023

JHEP Reports

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“…Ammonia is a proven cornerstone in the complex pathophysiology of HE (1). In addition, the prognostic value of ammonia measurement for predicting hospitalizations and mortality in outpatients with cirrhosis was recently demonstrated by a large multicenter study and subsequent validation (30,31). However, the correlation between serum ammonia levels and the presence of MHE is controversial, and studies are conflicting and limited by small sample sizes (32)(33)(34).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Minimal Hepatic Encephalopathy in Patients With Liver Cirrhosis: A Multicenter Study

et al. 2023

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INTRODUCTION:The prevalence of minimal hepatic encephalopathy (MHE), in particular in different subgroups, remains unknown. This study aimed to analyze the prevalence of MHE in different subgroups to identify patients at high risk and to pave the way for personalized screening approaches.METHODS:In this study, data of patients recruited at 10 centers across Europe and the United States were analyzed. Only patients without clinical signs of hepatic encephalopathy were included. MHE was detected using the Psychometric Hepatic Encephalopathy Score (PHES, cut-off < or ≤−4 depending on local norms). Clinical and demographic characteristics of the patients were assessed and analyzed.RESULTS:In total, 1,868 patients with cirrhosis with a median model for end-stage liver disease (MELD) of 11 were analyzed (Child-Pugh [CP] stages: A 46%, B 42%, and C 12%). In the total cohort, MHE was detected by PHES in 650 patients (35%). After excluding patients with a history of overt hepatic encephalopathy, the prevalence of MHE was 29%. In subgroup analyses, the prevalence of MHE in patients with CP A was low (25%), whereas it was high in CP B or C (42% and 52%). In patients with a MELD score <10, the prevalence of MHE was only 25%, but it was 48% in patients with a MELD score ≥20. Standardized ammonia levels (ammonia level/upper limit of normal of each center) correlated significantly, albeit weakly with PHES (Spearman ρ = −0.16, P < 0.001).DISCUSSION:The prevalence of MHE in patients with cirrhosis was high but varied substantially between diseases stages. These data may pave the way for more individualized MHE screening approaches.

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“…An AMM-ULN of 1.4 times was identified as the optimal cut-off to define the risk of hospitalization and mortality (17). These results were validated in three external cohorts of 130 (17), 147 (33) and in 549 patients (18). In the latter study, the authors also demonstrated that venous ammonia predicts hepatic decompensation, non-elective liver-related hospitalisation, ACLF and liver-related deaths, independently of established prognostic indicators including C-reactive protein and HVPG (18).…”

Section: Ammonia As a Prognostic Biomarker In The Outpatient Settingmentioning

confidence: 83%

The value of ammonia as a biomarker in patients with cirrhosis

Ballester,

Durmazer,

et al. 2024

Semin Liver Dis

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Ammonia is a product of amino acid metabolism that accumulates in the blood of patients with cirrhosis and plays a pivotal role in the pathogenesis of hepatic encephalopathy (HE). Despite being one of the main drivers of brain dysfunction, for many years international societies stated that increased blood ammonia does not add any diagnostic, staging, or prognostic value for HE in patients with cirrhosis. Nonetheless, in the last decades, evidence is emerging that supports the utility of ammonia for risk stratification, but its role in guiding HE diagnosis, staging and treatment is unclear and there is equipoise in its use in clinical practice. This review provides the latest evidence on the value of ammonia as a biomarker in patients with cirrhosis. Although correct measurement of ammonia requires disciplined sample collection, it provides extremely useful clinical guidance for the diagnosis of HE, offers prognostic information and it defines a therapeutic target.

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Ammonia - an old friend with a new area of application

Cited by 5 publications

References 4 publications

Impact of ammonia levels on outcome in clinically stable outpatients with advanced chronic liver disease

Impact of ammonia levels on outcome in clinically stable outpatients with advanced chronic liver disease

Prevalence of Minimal Hepatic Encephalopathy in Patients With Liver Cirrhosis: A Multicenter Study

The value of ammonia as a biomarker in patients with cirrhosis

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