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

作者：Lorenz Balcar, Julia Krawanja, Bernhard Scheiner, Rafael Paternostro, Benedikt Simbrunner, Georg Semmler, Mathias Jachs, Lukas Hartl, Albert Friedrich Stättermayer, Philipp Schwabl, Matthias Pinter, Thomas Szekeres, Michael Trauner, Thomas Reiberger, Mattias Mandorfer · 发表于：JHEP Reports · 年份：2023 · DOI：10.1016/j.jhepr.2023.100682 · 被引用次数：28 · 研究领域：Liver Disease and Transplantation、Liver Disease Diagnosis and Treatment、Organ Transplantation Techniques and Outcomes

Background & Aims 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). Methods (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). Results (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 <0.001), non-elective liver-related hospitalisation (aHR: 1.86 [95% CI: 1.17–2.95]; p = 0.008), and – in those with decompensated advanced chronic liver disease – acute-on-chronic liver failure (aHR: 1.71 [95% CI: 1.05–2.80]; p = 0.031). (ii) Besides hepatic venous pressure gradient, veno...