Clinical impact of arterial ammonia levels in ICU patients with different liver diseases
Standard
Clinical impact of arterial ammonia levels in ICU patients with different liver diseases. / Drolz, Andreas; Jäger, Bernhard; Wewalka, Marlene; Saxa, Reinhard; Horvatits, Thomas; Roedl, Kevin; Perkmann, Thomas; Zauner, Christian; Kramer, Ludwig; Ferenci, Peter; Fuhrmann, Valentin.
In: INTENS CARE MED, Vol. 39, No. 7, 01.07.2013, p. 1227-37.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Clinical impact of arterial ammonia levels in ICU patients with different liver diseases
AU - Drolz, Andreas
AU - Jäger, Bernhard
AU - Wewalka, Marlene
AU - Saxa, Reinhard
AU - Horvatits, Thomas
AU - Roedl, Kevin
AU - Perkmann, Thomas
AU - Zauner, Christian
AU - Kramer, Ludwig
AU - Ferenci, Peter
AU - Fuhrmann, Valentin
PY - 2013/7/1
Y1 - 2013/7/1
N2 - 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.
AB - 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.
KW - Adult
KW - Aged
KW - Ammonia
KW - Austria
KW - Biological Markers
KW - Case-Control Studies
KW - Disease-Free Survival
KW - Female
KW - Hepatitis
KW - Humans
KW - Liver Cirrhosis
KW - Liver Failure, Acute
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Prognosis
KW - Prospective Studies
U2 - 10.1007/s00134-013-2926-8
DO - 10.1007/s00134-013-2926-8
M3 - SCORING: Journal article
C2 - 23636826
VL - 39
SP - 1227
EP - 1237
JO - INTENS CARE MED
JF - INTENS CARE MED
SN - 0342-4642
IS - 7
ER -