Dynamic assessments of hepatic encephalopathy and ammonia levels predict mortality in acute-on-chronic liver failure

Verma, Nipun; Dhiman, Radha K.; Choudhury, Ashok; Taneja, Sunil; Duseja, Ajay; Singh, Virender; Mahtab, Mamun Al; Devarbhavi, Harshad; Shukla, Akash; Ning, Qin; Salehiniya, Hamid; Butt, Amna; Jafri, Wasim; Tan, Soek Siam; Hu, Jinhua; Duan, Zhongping; Treeprasertsuk, Sombat; Lee, Guan Huei; Ghazinyan, Hasmik; Lesmana, Laurentius A.; Sood, Ajit; Midha, Vandana; Kim, Dong Joon; Eapen, C E; Goel, Ashish; Han, Tao; Xin, Shaojie; Nan, Yuemin; Dokmeci, A. Kadir; Sahu, Manoj Kumar; Singh, Ayaskanta; Arora, Anil; Kumar, Ashish; Kumar, Ramesh; Prasad, V G Mohan; Shresta, Ananta; Sollano, José D.; Payawal, Diana A.; Shah, Samir; Rao, Padaki Nagaraja; Kulkarni, Anand V.; Lau, George; Sarin, Shiv Kumar

doi:10.1007/s12072-021-10221-7

Cited by 33 publications

(13 citation statements)

References 19 publications

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“…8 Recently, ammonia levels have been shown to be an independent predictor of mortality in patients with acute decompensation or acute-on-chronic liver failure irrespective of the severity of HE, suggesting that it may be a useful biomarker for predicting other liver-related complications. [9][10][11][12] We hypothesised that hyperammonaemia is a risk factor for the development of not only HE but also other liver-related complications and consequent mortality in clinically stable outpatients with cirrhosis. In this study, our primary aim was to determine whether ammonia levels define the risk of subsequent hospitalisation with liver-related complications such as bacterial infection, variceal bleeding, overt HE and ascites.…”

Section: Introductionmentioning

confidence: 99%

Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis

Tranah

Ballester²,

Carbonell-Asíns³

et al. 2022

Journal of Hepatology

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Section: Introductionmentioning

confidence: 99%

Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis

Tranah

Ballester²,

Carbonell-Asíns³

et al. 2022

Journal of Hepatology

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“…[4,5] Elevated ammonia levels play a vital role in the occurrence and development of HE owing to the reduced metabolic capacity of the liver. [6] Gut microbiome dysregulation is linked to numerous diseases and pro-inflammatory states, such as irritable bowel syndrome, rheumatoid arthritis, systemic lupus erythematosus and liver cirrhosis. [7,8] In the presence of gut microbiome dysregulation, the immune system could be erroneously directed in favor of pro-inflammatory pathways to instigate different diseases.…”

Section: Introductionmentioning

confidence: 99%

“…[ 4 , 5 ] Elevated ammonia levels play a vital role in the occurrence and development of HE owing to the reduced metabolic capacity of the liver. [ 6 ]…”

Section: Introductionmentioning

confidence: 99%

Alterations of gut microbiome and effects of probiotic therapy in patients with liver cirrhosis: A systematic review and meta-analysis

Huang

Peng

et al. 2022

Medicine

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Background: Alterations in the gut microbiome usually occur in liver cirrhosis. Gut microbiome dysregulation damages the liver and accelerates the development of liver fibrosis. Probiotic treatment has gradually become a major method for improving the prognosis of liver cirrhosis and reducing its complications. However, alterations in the gut microbiome have revealed different results, and the therapeutic effects of various probiotics are inconsistent. Methods: We searched the PubMed, Medline, EMBASE, ScienceDirect, and Cochrane databases up to August 2022 and conducted a systematic review and meta-analysis of 17 relevant studies. Results: The counts of Enterobacter (standardized mean difference [SMD] −1.79, 95% confidence interval [CI]: −3.08 to −0.49) and Enterococcus (SMD −1.41, 95% CI: −2.26 to −0.55) increased significantly in patients with cirrhosis, while the counts of Lactobacillus (SMD 0.63, 95% CI: 0.12–1.15) and Bifidobacterium (SMD 0.44, 95% CI: 0.12–0.77) decreased significantly. Blood ammonia (weighted mean difference [WMD] 14.61, 95% CI: 7.84–21.37) and the incidence of hepatic encephalopathy (WMD 0.40, 95% CI: 0.27–0.61) were significantly decreased in the probiotic group. As for mortality (MD 0.75, 95% CI: 0.48–1.16) and the incidence of spontaneous bacterial peritonitis (WMD −0.02, 95% CI: −0.07 to 0.03), no significant differences were found between the probiotic and placebo groups. Conclusion: In summary, the gut microbiome in cirrhosis manifests as decreased counts of Lactobacillus and Bifidobacterium and increased counts of Enterobacter and Enterococcus . Targeted supplementation of probiotics in cirrhosis, including Lactobacillus combined with Bifidobacterium or Bifidobacterium alone, can reduce blood ammonia and the incidence of hepatic encephalopathy. The effect is similar to that of lactulose, but it has no obvious effect on mortality and spontaneous bacterial peritonitis.

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“…Consistent with our study, Verma et al . 17 found that ammonia level was a significant predictor of HE occurrence and HE classification; in addition to the above-mentioned factors, they also identified ammonia, lactate, and systemic inflammatory response syndrome as independent predictors of 30-day mortality in patients with ACLF. Elevated WBC counts suggest potential infection, and the CLIF C-ACLF model incorporates WBC in the calculation equation, with high levels of WBC associated with increased risk of ACLF mortality.…”

Section: Discussionmentioning

confidence: 92%

Development of a Widely Applicable and Simple Prognostic Score for Patients with Acute-on-chronic Liver Failure

Yu¹,

Li²,

Zhou³

et al. 2022

J Clin Transl Hepatol

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Background and Aims Acute-on-chronic liver failure (ACLF) tends to progress rapidly with high short-term mortality. We aimed to create a widely applicable, simple prognostic (WASP) score for ACLF patients. Methods A retrospective cohort of ACLF cases recruited from three centers in China were divided into training and validation sets to develop the new score. A prospective longitudinal cohort was recruited for further validation. Results A total of 541 cases were included in the training set, and seven independent ACLF prognostic factors were screened to construct a new quantitative WASP-ACLF table. In the validation set of 671 cases, WASP-ACLF showed better predictive ability for 28-day and 90-day mortality than the currently used prognostic scores at baseline, day 3, week 1, and week 2. The predictive efficacy and clinical validity of the model improved over time. Patients were assigned to low-, intermediate-, and high-risk groups by their WASP-ACLF scores. Compared with the other two groups, intermediate-risk patients had a more uncertain prognosis, with a 90-day mortality of 44.4–50.6%. Sequential assessments at weeks 1 and 2 found the 90-day mortality of intermediate-risk groups was <20% for patients with a ≥2 point decrease in WASP-ACLF and was up to 56% for patients with a ≥2 points increase. Similar results were observed in prospective data. Conclusions The new ACLF prognostic score was simple, widely applicable, and had good predictive efficacy. Continuous assessments and trend of change in WASP-ACLF need to be considered, especially for intermediate-risk patients.

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Dynamic assessments of hepatic encephalopathy and ammonia levels predict mortality in acute-on-chronic liver failure

Cited by 33 publications

References 19 publications

Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis

Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis

Alterations of gut microbiome and effects of probiotic therapy in patients with liver cirrhosis: A systematic review and meta-analysis

Development of a Widely Applicable and Simple Prognostic Score for Patients with Acute-on-chronic Liver Failure

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