Prognostic value of serum ammonia in critical patients with non-hepatic disease: A prospective, observational, multicenter study-Reference-Cited by-同舟云学术

Prognostic value of serum ammonia in critical patients with non-hepatic disease: A prospective, observational, multicenter study

Published:2022-07-02 Issue:0 Volume:0 Page:
ISSN:2224-4018
Container-title:Journal of Translational Internal Medicine
language:en
Short-container-title:

Author:

Li Yue¹,Yao Zhipeng¹,Li Yunlong¹,Yang Zhenyu¹,Li Ming¹,Chen Zhendong²,Liu Shujie³,Gong Jianguo⁴,Huang Libin⁵,Xu Ping⁶,Li Yan⁷,Li Haihong⁸,Liu Xuan⁹,Zhang Li¹⁰,Zhang Guixia¹¹,Wang Hongliang¹

Affiliation:

1. Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University , Harbin , Heilongjiang Province , China

2. Department of Intensive Care Medicine, The First Affiliated Hospital of Jiamusi University , Jiamusi , Heilongjiang Province , China

3. Department of Intensive Care Medicine, Mudanjiang City Second People’s Hospital , Mudanjiang , Heilongjiang Province , China

4. Department of Intensive Care Medicine, The Fifth Affiliated Hospital of Harbin Medical University , Daqing , Heilongjiang Province , China

5. Department of Intensive Care Medicine, Harbin Fifth Hospital , Harbin , Heilongjiang Province , China

6. Department of Intensive Care Medicine, General Hospital of Heilongjiang Province Land Reclamation Bureau , Harbin , Heilongjiang Province , China

7. Department of Intensive Care Medicine, The First Hospital of Harbin , Harbin , Heilongjiang Province , China

8. Department of Intensive Care Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University , Mudanjiang , Heilongjiang Province , China

9. Department of Intensive Care Medicine, Jiamusi Central Hospital , Jiamusi , Heilongjiang Province , China

10. Department of Intensive Care Medicine, Daqing Oilfield General Hospital , Daqing , Heilongjiang Province , China

11. Department of Intensive Care Medicine, The Longnan Hospital of Daqing , Daqing , Heilongjiang Province , China

Abstract

Abstract Background and Objectives Non-hepatic hyperammonemia can damage the central nervous system (CNS), and possible prognostic factors are lacking. This study aimed to investigate the prognostic and risk factors for patients admitted to the intensive care unit (ICU). Materials and Methods This prospective, observational, multicenter study was conducted between November and December 2019 at 11 ICUs in the Chinese Heilongjiang province. Changes in blood ammonia level during and after ICU admission were continuously monitored and expressed as the high level (H-), mean level (M-), and initial level (I-) of ammonia. The risk factors of poor prognosis were investigated by conducting univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive ability of Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE-II) score, lactic acid, total bilirubin (TBil), and M-ammonia. Results A total of 1060 patients were included in this study, of which 707 (67%) had a favorable prognosis and 353 (33%) had a poor prognosis. As shown by univariate models, a poor prognosis was associated with elevated serum levels of lactic acid, TBil, and ammonia (P < 0.05) and pathologic scores from three assessments: APACHE-II, Glasgow Coma Scale (GCS), and Sequential Organ Failure Assessment (SOFA). Multivariate analysis revealed that circulating mean ammonia levels in ICU patients were independently associated with a poor prognosis (odds ratio [OR] = 1.73, 95% confidence interval [CI]: 1.07–2.80, P = 0.02). However, the APACHE-II score (area under the curve [AUC]: 0.714, sensitivity: 0.86, specificity: 0.68, P < 0.001) remained the most predictive factor for patient prognosis by ROC analysis. Conclusion Elevated serum levels of ammonia in the blood were independently prognostic for ICU patients without liver disease.

Publisher

Walter de Gruyter GmbH

Subject

Internal Medicine

Link

https://www.degruyter.com/document/doi/10.2478/jtim-2022-0021/pdf

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