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Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis

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العنوان: Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis
المؤلفون: Thomas H. Tranah, María-Pilar Ballester, Juan Antonio Carbonell-Asins, Javier Ampuero, Gonçalo Alexandrino, Andra Caracostea, Yolanda Sánchez-Torrijos, Karen L. Thomsen, Annarein J.C. Kerbert, María Capilla-Lozano, Manuel Romero-Gómez, Desamparados Escudero-García, Carmina Montoliu, Rajiv Jalan, Debbie L. Shawcross
المساهمون: Medical Research Council (UK), Instituto de Salud Carlos III, Fundación Ramón Areces, Generalitat Valenciana, European Commission, Tranah, Thomas H., Montoliu, Carmina, Jalan, Rajiv, Shawcross, Debbie L.
المصدر: Tranah, T H, Ballester, M P, Carbonell-Asins, J A, Ampuero, J, Alexandrino, G, Caracostea, A, Sánchez-Torrijos, Y, Thomsen, K L, Kerbert, A J C, Capilla-Lozano, M, Romero-Gómez, M, Escudero-García, D, Montoliu, C, Jalan, R & Shawcross, D L 2022, ' Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis ', Journal of Hepatology, vol. 77, no. 6, pp. 1554-1563 . https://doi.org/10.1016/j.jhep.2022.07.014
بيانات النشر: Elsevier BV, 2022.
سنة النشر: 2022
مصطلحات موضوعية: Liver Cirrhosis, Liver-related complications, Variceal bleeding, Hepatology, Ascites, Esophageal and Gastric Varices, Severity of Illness Index, Hospitalization, Cirrhosis, Ammonia, Hepatic Encephalopathy, Outpatients, Humans, Hyperammonemia, Prospective Studies, Bacterial infection, Gastrointestinal Hemorrhage, Hepatic encephalopathy
الوصف: [Background & Aims] Hyperammonaemia is central in the pathogenesis of hepatic encephalopathy. It also has pleiotropic deleterious effects on several organ systems, such as immune function, sarcopenia, energy metabolism and portal hypertension. This study was performed to test the hypothesis that severity of hyperammonaemia is a risk factor for liver-related complications in clinically stable outpatients with cirrhosis.
[Methods] We studied 754 clinically stable outpatients with cirrhosis from 3 independent liver units. Baseline ammonia levels were corrected to the upper limit of normal (AMM-ULN) for the reference laboratory. The primary endpoint was hospitalisation with liver-related complications (a composite endpoint of bacterial infection, variceal bleeding, overt hepatic encephalopathy, or new onset or worsening of ascites). Multivariable competing risk frailty analyses using fast unified random forests were performed to predict complications and mortality. External validation was carried out using prospective data from 130 patients with cirrhosis in an independent tertiary liver centre.
[Results] Overall, 260 (35%) patients were hospitalised with liver-related complications. On multivariable analysis, AMM-ULN was an independent predictor of both liver-related complications (hazard ratio 2.13; 95% CI 1.89–2.40; p
[Conclusion] Ammonia is an independent predictor of hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis and performs better than traditional prognostic scores in predicting complications.
This research was funded by the Medical Research Council (MR/V006757/1) and Instituto de Salud Carlos III (FIS PI18/00150); Fundación Ramón Areces, Consellería de Educación Generalitat Valenciana (PROMETEOII/2018/051), co-funded with European Regional Development Funds (ERDF). THT is supported by a Medical Research Council, Clinical Research Training Fellowship (MR/V006757/1). MPB is supported by a Río Hortega award (CM19/00212), Instituto de Salud Carlos III.
وصف الملف: application/pdf
تدمد: 0168-8278
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d31b2501a63e76ce68891a3d44c8d7b1
https://doi.org/10.1016/j.jhep.2022.07.014
حقوق: OPEN
رقم الأكسشن: edsair.doi.dedup.....d31b2501a63e76ce68891a3d44c8d7b1
قاعدة البيانات: OpenAIRE
الوصف
تدمد:01688278