The DOI matches its Crossref record; 32 of the 32 references it cites were found in a registry or an index.
Arterial ammonia and clinical risk factors for encephalopathy and intracranial hypertension in acute liver failure
Open accessAbstract
High circulating ammonia concentrations are common in patients with acute liver failure (ALF) and are associated with hepatic encephalopathy (HE) and intracranial hypertension (ICH). Other risk factors are poorly characterized. We evaluated the relation of the admission arterial ammonia concentration and other clinical variables with the development of HE and ICH. Arterial ammonia was measured on admission to the intensive care unit in 257 patients; 165 had ALF and severe HE, and there were 3 control groups: acute hepatic dysfunction without severe HE (n = 50), chronic liver disease (n = 33), and elective surgery (n = 9). Variables associated with ICH and HE were investigated with regression analysis. Ammonia was higher in ALF patients than controls. An independent risk factor for the development of severe HE and ICH, a level greater than 100 μmol/L predicted the onset of severe HE with 70% accuracy. The model for end-stage liver disease (MELD) score was also independently predictive of HE, and its combination with ammonia increased specificity and accuracy. ICH developed in 55% of ALF patients with a level greater than 200 μmol/L, although this threshold failed to identify most cases. After admission, ammonia levels remained high in those developing ICH and fell in those who did not. Youth, a requirement for vasopressors, and renal replacement therapy were additional independent risk factors. Conclusion: Ammonia is an independent risk factor for the development of both HE and ICH. Additional MELD scoring improved the prediction of HE. Factors other than ammonia also appear important in the pathogenesis of ICH. Ammonia measurements could form part of risk stratification for HE and ICH, identifying patients for ammonia-lowering therapies and invasive monitoring. (Hepatology 2007.)
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Cites
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The systemic inflammatory response syndrome in acute liver failure
Rolando, N., Wade, J., Davalos, M., Wendon, J., Philpott-Howard, J., & Williams, R. (2000) · Hepatology · doi:10.1053/jhep.2000.17687 · Cited by 729
Self-citationClemmesen, J. O., Larsen, F. S., Kondrup, J., Hansen, B. A., & Ott, P. (1999) · Hepatology · doi:10.1002/hep.510290309 · Cited by 669
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Correlation between ammonia levels and the severity of hepatic encephalopathy
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Glutamine: A Trojan horse in ammonia neurotoxicity†
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Cited by
Bernal, W., & Wendon, J. (2013) · New England Journal of Medicine · doi:10.1056/nejmra1208937 · Cited by 1,169
Self-citationEASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure
Wendon, J., Cordoba, J., Dhawan, A., Larsen, F. S., Manns, M., Nevens, F., Samuel, D., Simpson, K. J., Yaron, I., & Bernardi, M. (2017) · Journal of Hepatology · doi:10.1016/j.jhep.2016.12.003 · Cited by 917
Self-citationStravitz, R. T., & Lee, W. M. (2019) · The Lancet · doi:10.1016/s0140-6736(19)31894-x · Cited by 844
Larsen, F. S., Schmidt, L. E., Bernsmeier, C., Rasmussen, A., Isoniemi, H., Patel, V. C., Triantafyllou, E., Bernal, W., Auzinger, G., Shawcross, D., et al. (2016) · Journal of Hepatology · doi:10.1016/j.jhep.2015.08.018 · Cited by 659
Self-citationHepatic encephalopathy: Novel insights into classification, pathophysiology and therapy
Rose, C. F., Amodio, P., Bajaj, J. S., Dhiman, R. K., Montagnese, S., Taylor-Robinson, S. D., Vilstrup, H., & Jalan, R. (2020) · Journal of Hepatology · doi:10.1016/j.jhep.2020.07.013 · Cited by 470
Metadata
- Authors
- Bernal, W., Hall, C., Karvellas, C. J., Auzinger, G., Sizer, E., & Wendon, J.
- Venue
- Hepatology
- Published
- 2007-12
- Volume
- 46
- Issue
- 6
- Pages
- 1844-1852
- ISSN
- 0270-9139 (ISSN-L)
- OpenAlex
- W1979486195
- Cited by
- 480
- References
- 32
- FWCI
- 11.14
- Type
- journal article
- Language
- en
- Open access
- bronze
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
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