Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis

Autor: Thomas H. Tranah, María-Pilar Ballester, Juan Antonio Carbonell-Asins, Javier Ampuero, Gonçalo Alexandrino, Andra Caracostea, Yolanda Sánchez-Torrijos, Karen L. Thomsen, Annarein J.C. Kerbert, María Capilla-Lozano, Manuel Romero-Gómez, Desamparados Escudero-García, Carmina Montoliu, Rajiv Jalan, Debbie L. Shawcross
Přispěvatelé: Medical Research Council (UK), Instituto de Salud Carlos III, Fundación Ramón Areces, Generalitat Valenciana, European Commission, Tranah, Thomas H., Montoliu, Carmina, Jalan, Rajiv, Shawcross, Debbie L.
Rok vydání: 2022
Předmět:
Zdroj: Tranah, T H, Ballester, M P, Carbonell-Asins, J A, Ampuero, J, Alexandrino, G, Caracostea, A, Sánchez-Torrijos, Y, Thomsen, K L, Kerbert, A J C, Capilla-Lozano, M, Romero-Gómez, M, Escudero-García, D, Montoliu, C, Jalan, R & Shawcross, D L 2022, ' Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis ', Journal of Hepatology, vol. 77, no. 6, pp. 1554-1563 . https://doi.org/10.1016/j.jhep.2022.07.014
ISSN: 0168-8278
DOI: 10.1016/j.jhep.2022.07.014
Popis: [Background & Aims] Hyperammonaemia is central in the pathogenesis of hepatic encephalopathy. It also has pleiotropic deleterious effects on several organ systems, such as immune function, sarcopenia, energy metabolism and portal hypertension. This study was performed to test the hypothesis that severity of hyperammonaemia is a risk factor for liver-related complications in clinically stable outpatients with cirrhosis.
[Methods] We studied 754 clinically stable outpatients with cirrhosis from 3 independent liver units. Baseline ammonia levels were corrected to the upper limit of normal (AMM-ULN) for the reference laboratory. The primary endpoint was hospitalisation with liver-related complications (a composite endpoint of bacterial infection, variceal bleeding, overt hepatic encephalopathy, or new onset or worsening of ascites). Multivariable competing risk frailty analyses using fast unified random forests were performed to predict complications and mortality. External validation was carried out using prospective data from 130 patients with cirrhosis in an independent tertiary liver centre.
[Results] Overall, 260 (35%) patients were hospitalised with liver-related complications. On multivariable analysis, AMM-ULN was an independent predictor of both liver-related complications (hazard ratio 2.13; 95% CI 1.89–2.40; p
[Conclusion] Ammonia is an independent predictor of hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis and performs better than traditional prognostic scores in predicting complications.
This research was funded by the Medical Research Council (MR/V006757/1) and Instituto de Salud Carlos III (FIS PI18/00150); Fundación Ramón Areces, Consellería de Educación Generalitat Valenciana (PROMETEOII/2018/051), co-funded with European Regional Development Funds (ERDF). THT is supported by a Medical Research Council, Clinical Research Training Fellowship (MR/V006757/1). MPB is supported by a Río Hortega award (CM19/00212), Instituto de Salud Carlos III.
Databáze: OpenAIRE
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