Hyperammonemia in patients with acute decompensation of hepatic cirrhosis

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Abstract

Hyperammonemia is a pathogenetic component of hepatic encephalopathy (HE) in case of hepatic cirrhosis (HC). However, its diagnostic and prognostic value in acute decompensation of LC remains less well studied.

The aim: to evaluate the diagnostic and prognostic value of capillary blood ammonia level in patients with acute decompensation of LC.

Material and methods. The study included 150 patients with HC (83 male and 67 female individuals, mean age of them was 50.9 ± 11.2 years). Basing on the CLIF-C OF score, participants were divided into two groups: patients with decompensated hepatic cirrhosis without ACLF (decHC, n = 78; 52%) and patients with ACLF (n = 72; 48%). According to the severity of damage and number of affected organs, patients with ACLF were further stratified into three subgroups: ACLF 1 (n = 43; 59.7%), ACLF 2 (n = 20; 27.8%), and ACLF 3 (n = 9; 12.5%). Capillary blood ammonia level was measured using the microdiffusion method. The association of hyperammonemia with the severity of HE according to the West – Haven scale and with 28- and 90-day mortality was assessed.

Results. Blood ammonia level in the decHC and ACLF groups were 152.3 ± 58.8 and 156.1 ± 63.9 μmol/L, respectively (p = 0.785). This level increased with ACLF progression: 157.7 ± 57.9 in ACLF 1, 176.0 ± 50.5 μmol/L in ACLF 2, and 222.6 ± 48.1 μmol/L in ACLF 3 (p = 0.013). Patients with severe HE had higher ammonia levels than patients with latent encephalopathy (p = 0.035). Ammonia levels were also significantly higher in patients who died comparatively to those who survived, both at 28 (196.11 ± 60.05 vs. 161.93 ± 54.55 μmol/L; p = 0.009) and 90 (169.22 ± 60.54 vs. 148.89 ± 62.13 μmol/L; p = 0.018) days. The highest prognostic significance of hyperammonemia was found in ACLF 3.

Conclusion. In this study, the severity of hyperammonemia did not differ significantly between the decHC and ACLF groups; however, blood ammonia level increased as organ failure progressed. The obtained data indicate that ammonia has high diagnostic value for severe HE and serves as a predictor of mortality, especially in patients with ACLF 3. Monitoring of ammonia level and correction of hyperammonemia are clinically significant in patients with acute decompensation of hepatic cirrhosis.

About the authors

Lyudmila Y. Ilchenko

Pirogov Russian National Research Medical University

Email: ilchenko-med@yandex.ru
ORCID iD: 0000-0001-6029-1864

MD, Dr. Sci. (Medicine), professor of the Department of hospital therapy named after academician G.I. Storozhakov of the Institute of clinical medicine

Russian Federation, Moscow

Breshna M. Taraki

Pirogov Russian National Research Medical University

Author for correspondence.
Email: breshna98@mail.ru
ORCID iD: 0009-0001-3739-1151

MD, postgraduate student of the Department of hospital therapy named after academician G.I. Storozhakov of the Institute of clinical medicine, gastroenterologist

Russian Federation, Moscow

Khaibar Azizulla

Academician V. I. Shumakov National Medical Research Center of Transplantology and Artificial Organs

Email: azizulla.haibar@yandex.ru
ORCID iD: 0009-0001-0309-9021

MD, surgeon

Russian Federation, Moscow

Imara G. Adamova

Pirogov Russian National Research Medical University

Email: miss.imara@mail.ru
ORCID iD: 0009-0007-7575-8341

MD, postgraduate student of the Department of hospital therapy named after academician G.I. Storozhakov of the Institute of clinical medicine

Russian Federation, Moscow

Lema A.K. Babarzai

Sechenov First Moscow State Medical University

Email: lema.100@mail.ru
ORCID iD: 0009-0004-4529-9509

student of the Institute of clinical medicine

Russian Federation, Moscow

Ilya G. Fedorov

Pirogov Russian National Research Medical University; V.M. Buyanov City Clinical Hospital

Email: fedorovig1@zdrav.mos.ru
ORCID iD: 0000-0003-1003-539X

MD, PhD (Medicine), associate professor of the Department of hospital therapy named after Academician G.I. Storozhakov of the Institute of clinical medicine, head of the Department of gastroenterology

Russian Federation, Moscow; Moscow

Igor G. Nikitin

Pirogov Russian National Research Medical University

Email: Igor.nikitin.64@mail.ru
ORCID iD: 0000-0003-1699-0881

MD, Dr. Sci. (Medicine), professor, head of the Department of hospital therapy named after academician G.I. Storozhakov of the Institute of clinical medicine

Russian Federation, Moscow

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