Impact of ammonia levels on outcome in clinically stable outpatients with advanced chronic liver disease

• Published in: JHEP reports 2023-04, Vol.5 (4), p.100682-100682, Article 100682
• Main Authors: Balcar, Lorenz, Krawanja, Julia, Scheiner, Bernhard, Paternostro, Rafael, Simbrunner, Benedikt, Semmler, Georg, Jachs, Mathias, Hartl, Lukas, Stättermayer, Albert Friedrich, Schwabl, Philipp, Pinter, Matthias, Szekeres, Thomas, Trauner, Michael, Reiberger, Thomas, Mandorfer, Mattias
• Format: Article
• Language: English
• Subjects: Acute-on-chronic liver failure; Cirrhosis; Death; Decompensation; Hepatic encephalopathy
• ISSN: 2589-5559; 2589-5559
• DOI: 10.1016/j.jhepr.2023.100682

Ammonia levels predicted hospitalisation in a recent landmark study not accounting for portal hypertension and systemic inflammation severity. We investigated (i) the prognostic value of venous ammonia levels (outcome cohort) for liver-related outcomes while accounting for these factors and (ii) its correlation with key disease-driving mechanisms (biomarker cohort). (i) The outcome cohort included 549 clinically stable outpatients with evidence of advanced chronic liver disease. (ii) The partly overlapping biomarker cohort comprised 193 individuals, recruited from the prospective Vienna Cirrhosis Study (VICIS: NCT03267615). (i) In the outcome cohort, ammonia increased across clinical stages as well as hepatic venous pressure gradient and United Network for Organ Sharing model for end-stage liver disease (2016) strata and were independently linked with diabetes. Ammonia was associated with liver-related death, even after multivariable adjustment (adjusted hazard ratio [aHR]: 1.05 [95% CI: 1.00–1.10]; p = 0.044). The recently proposed cut-off (≥1.4 × upper limit of normal) was independently predictive of hepatic decompensation (aHR: 2.08 [95% CI: 1.35–3.22]; p