Ammonia and urea metabolism in acute liver failure: A multicentre cohort study

Background & Aims Ammonia is metabolized into urea in the liver. In acute liver failure (ALF), ammonia has been associated with survival. However, urea variation has been poorly studied. Methods Observational cohort including ALF patients from Curry Cabral Hospital (Lisbon, Portugal) and Clinic...

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Published in:Liver international 2024-10, Vol.44 (10), p.2651-2659
Main Authors: Cardoso, Filipe S., Toapanta, David, Jimenez, Natalia, Fidalgo, Pedro, Figueiredo, António, Valdivieso, Miriam, Germano, Nuno, Rule, Jody A., Lee, William M., Abraldes, Juan G., Reverter, Enric, Karvellas, Constantine J.
Format: Article
Language:English
Subjects:
Adult
Age
Ammonia
Ammonia - blood
Body weight
Cohort Studies
Etiology
Female
hepatitis
Hospitals
Humans
Liver
Liver - metabolism
Liver Failure, Acute - blood
Liver Failure, Acute - mortality
liver regeneration
Liver Transplantation
Male
Middle Aged
necrosis
nitrogen
outcomes
Portugal
ROC Curve
Sex
Spain
Survival
transplant
Urea
Urea - blood
Urea - metabolism
Ureas
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Summary:Background & Aims Ammonia is metabolized into urea in the liver. In acute liver failure (ALF), ammonia has been associated with survival. However, urea variation has been poorly studied. Methods Observational cohort including ALF patients from Curry Cabral Hospital (Lisbon, Portugal) and Clinic Hospital (Barcelona, Spain) between 10/2010 and 01/2023. The United States ALF Study Group cohort was used for external validation. Primary exposures were serum ammonia and urea on ICU admission. Primary endpoint was 30‐day transplant‐free survival (TFS). Secondary endpoint was explanted liver weight. Results Among 191 ALF patients, median (IQR) age was 46 (32; 57) years and 85 (44.5%) were males. Overall, 86 (45.0%) patients were transplanted and 75 (39.3%) died. Among all ALF patients, following adjustment for age, sex, body weight, and aetiology, higher ammonia or lower urea was independently associated with higher INR on ICU admission (p 
ISSN:1478-3223
1478-3231
1478-3231
DOI:10.1111/liv.16043