Clinical Impact of Arterial Ammonia Levels in ICU Patients with Different Liver Diseases

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2013 May 3

PMID 23636826

Citations 20

Authors

Andreas Drolz

Bernhard Jager

Marlene Wewalka

Reinhard Saxa

Thomas Horvatits

Kevin Roedl

Thomas Perkmann

Christian Zauner

Ludwig Kramer

Peter Ferenci

Valentin Fuhrmann

Affiliations

Soon will be listed here.

Abstract

Purpose: Increased arterial ammonia levels are associated with high mortality in patients with acute liver failure (ALF). Data on the prognostic impact of arterial ammonia is lacking in hypoxic hepatitis (HH) and scarce in critically ill patients with cirrhosis.

Methods: The patient cohort comprised 72 patients with HH, 43 patients with ALF, 100 patients with liver cirrhosis and 45 patients without evidence for liver disease. Arterial ammonia concentrations were assessed on a daily basis in all patients and the results were compared among these four patient groups and between 28-day survivors and 28-day non-survivors overall and in each group.

Results: Overall 28-day mortality rates in patients with HH, ALF and cirrhosis and in the control group were 54, 30, 49 and 27 %, respectively. Peak arterial ammonia levels differed significantly between transplant-free 28-day survivors and non-survivors in the HH and ALF groups (p < 0.01 for both). Multivariate regression identified peak arterial ammonia concentrations as an independent predictor of 28-day mortality or liver transplantation in patients with HH and ALF, respectively (p < 0.01). There was no association between mortality and arterial ammonia in patients with liver cirrhosis and in the control group. Admission arterial ammonia levels were independently linked to hepatic encephalopathy grades 3/4 in patients with HH (p < 0.01), ALF (p < 0.05) and cirrhosis (p < 0.05), respectively.

Conclusions: Elevated arterial ammonia levels indicate a poor prognosis in acute liver injury and are associated with advanced HE in HH, ALF and cirrhosis. Arterial ammonia levels provide additional information in the risk assessment of critically ill patients with liver disease.

Citing Articles

Impact of acute respiratory distress syndrome on outcome in critically ill patients with liver cirrhosis.

Tariparast P, Roedl K, Horvatits T, Drolz A, Kluge S, Fuhrmann V Sci Rep. 2025; 15(1):4301.

PMID: 39905232 PMC: 11794433. DOI: 10.1038/s41598-025-88606-z.

Down the road towards hepatic encephalopathy. The elusive ammonia- what determines the arterial concentration?.

Ott P, Eriksen P, Kjaergaard K, Sorensen M, Thomsen K, Vilstrup H Metab Brain Dis. 2024; 40(1):48.

PMID: 39621139 PMC: 11611965. DOI: 10.1007/s11011-024-01435-3.

[Liver diseases in the intensive care unit].

Roedl K, Fuhrmann V Med Klin Intensivmed Notfmed. 2024; 119(6):449-457.

PMID: 38937335 DOI: 10.1007/s00063-024-01157-5.

Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients.

Perez Ruiz de Garibay A, Kortgen A, Leonhardt J, Zipprich A, Bauer M Crit Care. 2022; 26(1):289.

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Hepatic encephalopathy.

Haussinger D, Dhiman R, Felipo V, Gorg B, Jalan R, Kircheis G Nat Rev Dis Primers. 2022; 8(1):43.

PMID: 35739133 DOI: 10.1038/s41572-022-00366-6.

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