Association between blood ammonia and 90-day prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure

Tong JingJing; Mu XiuYing; Xu Xiang; Chen Jing; Zhai XingRan; Wang Yu; Su HaiBin; Liu XiaoYan; Hu JinHua

doi:10.3969/j.issn.1001-5256.2019.06.024

Volume 35 Issue 6

Jun. 2019

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Article Navigation > Journal of Clinical Hepatology > 2019 > 35(6): 1304-1307

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Association between blood ammonia and 90-day prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2019.06.024

Liver Failure Treatment and Research Center, The Fifth Medical Center of Chinese PLA General Hospital

Received Date: 2019-04-11
Published Date: 2019-06-20

Abstract

Abstract

Objective To investigate the association between baseline blood ammonia (BLA) and 90-day prognosis in patients with hepatitis B virus (HBV) -related acute-on-chronic liver failure (HBV-ACLF) . Methods A retrospective analysis was performed for the clinical data of 789 patients with HBV-ACLF who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January2013 to December 2016, and the association between baseline BLA and 90-day prognosis was analyzed. The Cox regression risk model was used for multivariate analysis. The Kaplan-Meier survival curve was used to analyze the 90-day survival rate of patients with different levels of baseline BLA, and the log-rank test was used for comparison. Results The Cox multivariate regression analysis showed that BLA was independently and positively correlated with the risk of 90-day death in HBV-ACLF patients (Model 2: hazard ratio = 1. 007, 95%confidence interval: 1. 005-1. 010, P < 0. 00001) . The log-rank test indicated that in the patients without hepatic encephalopathy (HE) , the BLAhigh group had the highest 90-day cumulative mortality rate, followed by the BLAmid group and the BLAlow group (P = 0. 0023) ; among the patients with HE, the BLAhigh group had a significantly higher 90-day cumulative mortality rate than the other two groups (P= 0. 012) , while there was no significant difference in 90-day cumulative mortality rate between these two groups (P = 0. 18) . Conclusion Baseline BLA is independently and positively correlated with the risk of 90-day death in HBV-ACLF patients, and it may have a certain clinical value in treatment and prognostic evaluation.
- blood ammonia,
- hepatitis B virus,
- acute-on-chronic liver failure,
- prognosis

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References

[1]WIJDICKS EF.Hepatic Encephalopathy[J].N Engl J Med, 2016, 375 (17) :660-1670.

[2]TAPPER EB, JIANG ZG, PATWARDHAN VR.Refining the ammonia hypothesis:A physiology-driven approach to the treatment of hepatic encephalopathy[J].Mayo Clin Proc, 2015, 90 (5) :646-658.

[3]JIA B, YU ZJ, DUAN ZF, et al.Hyperammonaemia induces hepatic injury with alteration of gene expression profiles[J].Liver Int, 2014, 34 (5) :748-758.

[4]ALBILLOS A, LARIO M, ALVAREZ-MON M.Cirrhosis-associated immune dysfunction:Distinctive features and clinical relevance[J].J Hepatol, 2014, 61 (6) :1385-1396.

[5] SHAWCROSS DL, WRIGHT GA, STADLBAUER V, et al.Ammonia impairs neutrophil phagocytic function in liver disease[J].Hepatology, 2008, 48 (4) :1202-1212.

[6]JALAN R, de CHIARA F, BALASUBRAMANIYAN V, et al.Ammonia produces pathological changes in human hepatic stellate cells and is a target for therapy of portal hypertension[J].J Hepatol, 2016, 64 (4) :823-833.

[7]LATTANZI B, D'AMBROSIO D, MERLI M.Hepatic encephalopathy and sarcopenia:Two faces of the same metabolic alteration[J].J Clin Exp Hepatol, 2019, 9 (1) :125-130.

[8]DASARATHY S, MERLI M.Sarcopenia from mechanism to diagnosis and treatment in liver disease[J].J Hepatol, 2016, 65 (6) :1232-1244.

[9]YOU S, RONG Y, ZHU B, et al.Changing etiology of liver failure in 3, 916 patients from northern China:A 10-year survey[J].Hepatol Int, 2013, 7 (2) :714-720.

[10]QIN G, SHAO JG, ZHU YC, et al.Population-representative Incidence of acute-on-chronic liver failure:A prospective cross-sectional study[J].J Clin Gastroenterol, 2016, 50 (8) :670-675.

[11]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会传染病学分会.慢性乙型肝炎防治指南 (2015更新) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[12]Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association;Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association.Guideline for diagnosis and treatment of liver failure (2018) [J].J Clin Hepatol, 2019, 35 (1) :38-44. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重症肝病与人工肝学组.肝衰竭诊治指南 (2018年版) [J].临床肝胆病杂志, 2019, 35 (1) :38-44.

[13]SARIN SK, CHOUDHURY A.Acute-on-chronic liver failure:terminology, mechanisms and management[J].Nat Rev Gastroenterol Hepatol, 2016, 13 (3) :131-149.

[14]ZHANG DJ, ZHOU B, HOU JL.Research progress in prognostic models of acute-on-chronic liver failure[J].J Clin Hepatol, 2018, 34 (6) :1351-1356. (in Chinese) 张东敬, 周彬, 侯金林.慢加急性肝衰竭预后模型的研究进展[J].临床肝胆病杂志, 2018, 34 (6) :1351-1356.

[15]SHALIMAR, SHEIKH MF, MOOKERJEE RP.et al.Prognostic role of ammonia in patients with cirrhosis[J].Hepatology, 2019.

[16]RAVI S, BADE KS, HASANIN M, et al.Ammonia level at admission predicts in-hospital mortality for patients with alcoholic hepatitis[J].Gastroenterol Rep (Oxf) , 2017, 5 (3) :232-236.

[17]PATWARDHAN VR, JIANG ZG, RISECH-NEIMAN Y, et al.Serum ammonia in associated with transplant-free survival in hospitalized patients with acutely decompensated cirrhosis[J].J Clin Gastroenterol, 2016, 50 (4) :345-350.

[18]SUN C, ZHAO JY, LU ZM.Research on regulating the blood ammoniathrough silencing Rhc glycoprotein by small interfering RNA[J].Trauma Crit Care Med, 2019, 7 (1) :16-19. (in Chinese) 孙晨, 赵骥越, 卢再鸣.小干扰RNA通过沉默Rhc糖蛋白调节血氨研究[J].创伤与急危重医学, 2019, 7 (1) :16-19.

[19]CORDOBA J, VENTURA-COTS M, SIMON-TALERO M, et al.Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF) [J].J Hepatol, 2014, 60 (2) :275-281.

[20]ROMERO-GOMEZ M, MONTAGNESE S, JALAN R.Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure[J].J Hepatol, 2015, 62 (2) :437-447.

[21]SHAWCROSS DL, WRIGHT GA, STADLBAUER V, et al.Ammonia impairs neutrophil phagocytic function in liver disease[J].Hepatology, 2008, 48 (4) :1202-1212.

[22]LIU CP, YU ZJ.Study on L-Ornithine-L-Aspartate in the treatment of acute-on-chronic liver failure[J].Chin J Hepatol, 2011, 19 (1) :63-64. (in Chinese) 刘翠萍, 余祖江.全程门冬氨酸鸟氨酸治疗延缓乙型肝炎病毒相关慢加急性肝衰竭的进展[J].中华肝脏病杂志, 2011, 19 (1) :63-64.

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Association between blood ammonia and 90-day prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2019.06.024