Ammonia is associated with liver-related complications and predicts mortality in acute-on-chronic liver failure patients
Kessarin Thanapirom, Sombat Treeprasertsuk, Ashok Choudhury, Nipun Verma, Radha K. Dhiman, Mamun Al Mahtab, Harshad Devarbhavi, Akash Shukla, Saeed Hamid, Wasim Jafri, Soek Siam Tan, Guan Huei Lee, Hasmik Ghazinyan, Ajit Sood, Dong Joon Kim, C. E. Eapen, Tao Han, Nan Yuemin, A. Kadir Dökmeci, Manoj Kumar Sahu, Anil Arora, Ashish Kumar, Ramesh Kumar, V. G. Mohan Prasad, Ananta Shresta, Jose D. Sollano, Diana A. Payawal, George Lau, Shiv Kumar Sarin
Abstract
The relationship between ammonia and liver-related complications (LRCs) in acute-on-chronic liver failure (ACLF) patients is not clearly established. This study aimed to evaluate the association between ammonia levels and LRCs in patients with ACLF. The study also evaluated the ability of ammonia in predicting mortality and progression of LRCs. The study prospectively recruited ACLF patients based on the APASL definition from the ACLF Research Consortium (AARC) from 2009 to 2019. LRCs were a composite endpoint of bacterial infection, overt hepatic encephalopathy (HE), and ascites. A total of 3871 cases were screened. Of these, 701 ACLF patients were enrolled. Patients with LRCs had significantly higher ammonia levels than those without. Ammonia was significantly higher in patients with overt HE and ascites, but not in those with bacterial infection. Multivariate analysis found that ammonia was associated with LRCs. Additionally, baseline arterial ammonia was an independent predictor of 30-day mortality, but it was not associated with the development of new LRCs within 30 days. In summary, baseline arterial ammonia levels are associated with 30-day mortality and LRCs, mainly overt HE and ascites in ACLF patients.