Dynamic assessments of hepatic encephalopathy and ammonia levels predict mortality in acute-on-chronic liver failure

Verma N 1 , Dhiman RK 2 , Choudhury A 3 , Taneja S 1 , Duseja A 1 , Singh V 1 Show all authors , Al Mahtab M 4 , Devarbhavi H 5 , Shukla A 6 , Ning Q 7 , Hamid SS 8 , Butt AS 8 , Jafri W 8 , Tan SS 9 , Hu J 10 , Zhongping D 11 , Treeprasertsuk S 12 , Lee GH 13 , Ghazinyan H 14 , Lesmana LA 15 , Sood A 16 , Midha V 16 , Goyal O 16 , Kim DJ 17 , Eapen CE 18 , Goel A 18 , Tao H 19 , Shaojie X 20 , Yuemin N 21 , Dokmeci AK 22 , Sahu M 23 , Singh A 23 , Arora A 24 , Kumar A 24 , Kumar R 25 , Prasad VGM 26 , Shresta A 27 , Sollano J 28 , Payawal DA 29 , Shah S 30 , Rao PN 31 , Kulkarni A 31 , Lau GK 32 , Sarin SK 3 , APASL ACLF Research Consortium (AARC) for APASL ACLF working Party

Affiliations 

  • 1 Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • 2 Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. rkpsdhiman@hotmail.com
  • 3 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
  • 4 Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 5 Department of Hepatology, St John Medical College, Bangalore, India
  • 6 Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital, and Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
  • 7 Institute and Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 8 Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
  • 9 Department of Medicine, Hospital Selayang, Bata Caves, Selangor, Malaysia
  • 10 Department of Medicine, 302 Military Hospital, Beijing, China
  • 11 Translational Hepatology Institute Capital Medical University, Beijing You'an Hospital, Beijing, China
  • 12 Department of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 13 Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
  • 14 Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia
  • 15 Digestive Disease and GI Oncology Centre, Medistra Hospital, Jakarta, Indonesia
  • 16 Department of Gastroenterology, DMC, Ludhiana, India
  • 17 Department of Internal Medicine, Hallym University College of Medicine, Seoul, South Korea
  • 18 Department of Hepatology, CMC, Vellore, India
  • 19 Department of Hepatology and Gastroenterology, The Third Central Clinical College of Tianjin Medical University, No. 83, Jintang Road, Hedong District, Tianjin, 300170, China
  • 20 Liver Failure Treatment and Research Center, The Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
  • 21 Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, China
  • 22 Department of Medicine, Ankara University School of Medicine, Ankara, Turkey
  • 23 Department of Gastroenterology and Hepatology Sciences, IMS and SUM Hospital, Bhubaneswar, Odisha, India
  • 24 Institute of Liver Gastroenterology and Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
  • 25 Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India
  • 26 Department of Gastroenterology, VGM Hospital, Coimbatore, India
  • 27 Department of Hepatology, Foundation Nepal Sitapaila Height, Kathmandu, Nepal, India
  • 28 Department of Medicine, Cardinal Santos Medical Center, Manila, Philippines
  • 29 Fatima University Medical Center Manila, Manila, Philippines
  • 30 Global Hospitals, Mumbai, India
  • 31 Asian Institute of Gastroenterology, Hyderabad, India
  • 32 Department of Medicine, Humanity, and Health Medical Group, Hong Kong, People's Republic of China
Hepatol Int, 2021 Aug;15(4):970-982.
PMID: 34275111 DOI: 10.1007/s12072-021-10221-7

Abstract

BACKGROUND: We evaluated the dynamics of hepatic encephalopathy (HE) and ammonia estimation in acute-on-chronic liver failure (ACLF) patients due to a paucity of evidence.

METHODS: ACLF patients recruited from the APASL-ACLF Research Consortium (AARC) were followed up till 30 days, death or transplantation, whichever earlier. Clinical details, including dynamic grades of HE and laboratory data, including ammonia levels, were serially noted.

RESULTS: Of the 3009 ACLF patients, 1315 (43.7%) had HE at presentation; grades I-II in 981 (74.6%) and grades III-IV in 334 (25.4%) patients. The independent predictors of HE at baseline were higher age, systemic inflammatory response, elevated ammonia levels, serum protein, sepsis and MELD score (p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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