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Intensive Care Medicine
Published in: Intensive Care Medicine 7/2013

01-07-2013 | Original

Clinical impact of arterial ammonia levels in ICU patients with different liver diseases

Authors: Andreas Drolz, Bernhard Jäger, Marlene Wewalka, Reinhard Saxa, Thomas Horvatits, Kevin Roedl, Thomas Perkmann, Christian Zauner, Ludwig Kramer, Peter Ferenci, Valentin Fuhrmann

Published in: Intensive Care Medicine | Issue 7/2013

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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.
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Metadata
Title
Clinical impact of arterial ammonia levels in ICU patients with different liver diseases
Authors
Andreas Drolz
Bernhard Jäger
Marlene Wewalka
Reinhard Saxa
Thomas Horvatits
Kevin Roedl
Thomas Perkmann
Christian Zauner
Ludwig Kramer
Peter Ferenci
Valentin Fuhrmann
Publication date
01-07-2013
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 7/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-013-2926-8

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