Hyperammonemia in patients with acute decompensation of hepatic cirrhosis
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.L.Yu. Ilchenko, B.M. Taraki, H. Azizulla, I.G. Adamova, L.A.Kh. Babarzai, I.G. Fedorov, I.G. Nikitin
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.
Keywords
hyperammonemia
acute-on-chronic liver failure (ACLF)
decompensated hepatic cirrhosis
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About the Authors
Lyudmila Yu. Ilchenko, MD, Dr. Sci. (Medicine), professor of the Department of hospital therapy named after academician G.I. Storozhakov of the Institute of clinical medicine, Pirogov Russian National Research Medical University, Moscow, Russian Federation.E-mail: ilchenko-med@yandex.ru
ORCID: https://orcid.org/0000-0001-6029-1864
Breshna M. Taraki, MD, postgraduate student of the Department of hospital therapy named after academician
G.I. Storozhakov of the Institute of clinical medicine, Pirogov Russian National Research Medical University, gastroenterologist, Moscow, Russian Federation.
E-mail: breshna98@mail.ru
ORCID: https://orcid.org/0009-0001-3739-1151. Scopus ID 60516376000
Khaibar Azizulla, MD, surgeon, Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation.
E-mail: azizulla.haibar@yandex.ru
ORCID: https://orcid.org/0009-0001-0309-9021
Imara G. Adamova, MD, postgraduate student of the Department of hospital therapy named after academician
G.I. Storozhakov of the Institute of clinical medicine, Pirogov Russian National Research Medical University, gastroenterologist, Moscow, Russian Federation.
E-mail: miss.imara@mail.ru
ORCID: https://orcid.org/0009-0007-7575-8341
Lema A.Kh. Babarzai, student of the Institute of clinical medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation.
E-mail: lema.100@mail.ru
ORCID: https://orcid.org/0009-0004-4529-9509
Ilya G. Fedorov, MD, PhD (Medicine), associate professor of the Department of hospital therapy named after Academician G.I. Storozhakov of the Institute of clinical medicine, Pirogov Russian National Research Medical University; head of the Department of gastroenterology, V.M. Buyanov City Clinical Hospital, Moscow, Russian Federation.
E-mail: fedorovig1@zdrav.mos.ru
ORCID: https://orcid.org/0000-0003-1003-539X
Igor G. Nikitin, MD, Dr. Sci. (Medicine), professor, head of the Department of hospital therapy named after academician G.I. Storozhakov of the Institute of clinical medicine, Pirogov Russian National Research Medical University, Moscow, Russian Federation.
E-mail: Igor.nikitin.64@mail.ru
ORCID: https://orcid.org/0000-0003-1699-0881
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