Serum ammonia variation predicts mortality in patients with hepatitis B virus-related acute-on-chronic liver failure
BackgroundHyperammonemia is critical to the development of hepatic encephalopathy (HE) and is associated with mortality in end-stage liver disease. This study investigated the clinical value of ammonia variation in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients.MethodsA...
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Frontiers Media S.A.
2023-12-01
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| Series: | Frontiers in Microbiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmicb.2023.1282106/full |
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| author | Yi-Jing Cai Yi-Jing Cai Jia-Jia Dong Rui-Cong Chen Qian-Qian Xiao Xu-Mei Li De-Yuan Chen Chao Cai Xiu-Li Lin Ke-Qing Shi Ming-Qin Lu |
| author_facet | Yi-Jing Cai Yi-Jing Cai Jia-Jia Dong Rui-Cong Chen Qian-Qian Xiao Xu-Mei Li De-Yuan Chen Chao Cai Xiu-Li Lin Ke-Qing Shi Ming-Qin Lu |
| author_sort | Yi-Jing Cai |
| collection | DOAJ |
| description | BackgroundHyperammonemia is critical to the development of hepatic encephalopathy (HE) and is associated with mortality in end-stage liver disease. This study investigated the clinical value of ammonia variation in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients.MethodsA total of 276 patients with HBV-ACLF were retrospectively recruited. Patients' ammonia levels were serially documented. Baseline ammonia, Peak ammonia (highest level), and Trough ammonia (lowest level) were particularly corrected to the upper limit of normal (AMM-ULN). The primary endpoint was 28-day mortality.ResultsThe 28-day, 3-month, and 12-month mortality rates were 19.2, 25.7, and 28.2%, respectively. A total of 51 (18.4%) patients had overt HE (grade 2/3/4). Peak AMM-ULN was significantly higher in patients with overt HE and non-survivors compared with their counterparts (P < 0.001). Following adjustment for significant confounders, high Peak AMM-ULN was an independent predictor of overt HE (hazard ratio, 1.031, P < 0.001) and 28-day mortality (hazard ratio, 1.026, P < 0.001). The cut-off of Peak AMM-ULN was 1.8, determined by using the X-tile. Patients with Peak AMM-ULN appearing on days 1–3 after admission had a higher proportion of overt HE and mortality compared to other groups. Patients with decreased ammonia levels within 7 days had better clinical outcomes than those with increased ammonia.ConclusionSerum Peak ammonia was independently associated with overt HE and mortality in HBV-ACLF patients. Serial serum ammonia may have prognostic value. |
| first_indexed | 2024-03-09T03:10:47Z |
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| institution | Directory Open Access Journal |
| issn | 1664-302X |
| language | English |
| last_indexed | 2024-03-09T03:10:47Z |
| publishDate | 2023-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Microbiology |
| spelling | doaj.art-3c7a35a68f59400ea8ed12ce68f7d6382023-12-04T04:44:33ZengFrontiers Media S.A.Frontiers in Microbiology1664-302X2023-12-011410.3389/fmicb.2023.12821061282106Serum ammonia variation predicts mortality in patients with hepatitis B virus-related acute-on-chronic liver failureYi-Jing Cai0Yi-Jing Cai1Jia-Jia Dong2Rui-Cong Chen3Qian-Qian Xiao4Xu-Mei Li5De-Yuan Chen6Chao Cai7Xiu-Li Lin8Ke-Qing Shi9Ming-Qin Lu10Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, ChinaTranslational Medicine Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, ChinaDepartment of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, ChinaDepartment of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, ChinaDepartment of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, ChinaTranslational Medicine Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, ChinaDepartment of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, ChinaDepartment of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, ChinaDepartment of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, ChinaTranslational Medicine Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, ChinaDepartment of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, ChinaBackgroundHyperammonemia is critical to the development of hepatic encephalopathy (HE) and is associated with mortality in end-stage liver disease. This study investigated the clinical value of ammonia variation in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients.MethodsA total of 276 patients with HBV-ACLF were retrospectively recruited. Patients' ammonia levels were serially documented. Baseline ammonia, Peak ammonia (highest level), and Trough ammonia (lowest level) were particularly corrected to the upper limit of normal (AMM-ULN). The primary endpoint was 28-day mortality.ResultsThe 28-day, 3-month, and 12-month mortality rates were 19.2, 25.7, and 28.2%, respectively. A total of 51 (18.4%) patients had overt HE (grade 2/3/4). Peak AMM-ULN was significantly higher in patients with overt HE and non-survivors compared with their counterparts (P < 0.001). Following adjustment for significant confounders, high Peak AMM-ULN was an independent predictor of overt HE (hazard ratio, 1.031, P < 0.001) and 28-day mortality (hazard ratio, 1.026, P < 0.001). The cut-off of Peak AMM-ULN was 1.8, determined by using the X-tile. Patients with Peak AMM-ULN appearing on days 1–3 after admission had a higher proportion of overt HE and mortality compared to other groups. Patients with decreased ammonia levels within 7 days had better clinical outcomes than those with increased ammonia.ConclusionSerum Peak ammonia was independently associated with overt HE and mortality in HBV-ACLF patients. Serial serum ammonia may have prognostic value.https://www.frontiersin.org/articles/10.3389/fmicb.2023.1282106/fullammoniaAMMhepatitis B virusacute-on-chronic liver failurehepatic encephalopathy (HE)hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) |
| spellingShingle | Yi-Jing Cai Yi-Jing Cai Jia-Jia Dong Rui-Cong Chen Qian-Qian Xiao Xu-Mei Li De-Yuan Chen Chao Cai Xiu-Li Lin Ke-Qing Shi Ming-Qin Lu Serum ammonia variation predicts mortality in patients with hepatitis B virus-related acute-on-chronic liver failure Frontiers in Microbiology ammonia AMM hepatitis B virus acute-on-chronic liver failure hepatic encephalopathy (HE) hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) |
| title | Serum ammonia variation predicts mortality in patients with hepatitis B virus-related acute-on-chronic liver failure |
| title_full | Serum ammonia variation predicts mortality in patients with hepatitis B virus-related acute-on-chronic liver failure |
| title_fullStr | Serum ammonia variation predicts mortality in patients with hepatitis B virus-related acute-on-chronic liver failure |
| title_full_unstemmed | Serum ammonia variation predicts mortality in patients with hepatitis B virus-related acute-on-chronic liver failure |
| title_short | Serum ammonia variation predicts mortality in patients with hepatitis B virus-related acute-on-chronic liver failure |
| title_sort | serum ammonia variation predicts mortality in patients with hepatitis b virus related acute on chronic liver failure |
| topic | ammonia AMM hepatitis B virus acute-on-chronic liver failure hepatic encephalopathy (HE) hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) |
| url | https://www.frontiersin.org/articles/10.3389/fmicb.2023.1282106/full |
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