Prognostic Role of Ammonia in Critical Care Patients Without Known Hepatic Disease

Lina Zhao; Joseph Harold Walline; Yanxia Gao; Xin Lu; Shiyuan Yu; Zengzheng Ge; Huadong Zhu; Yi Li

doi:10.3389/fmed.2020.589825

Prognostic Role of Ammonia in Critical Care Patients Without Known Hepatic Disease

Front Med (Lausanne). 2020 Oct 22:7:589825. doi: 10.3389/fmed.2020.589825. eCollection 2020.

Authors

Lina Zhao¹, Joseph Harold Walline², Yanxia Gao³, Xin Lu¹, Shiyuan Yu¹, Zengzheng Ge¹, Huadong Zhu¹, Yi Li¹

Affiliations

¹ Emergency Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
² Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
³ Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Abstract

Background and Aims: Hyperammonemia usually develops because of hepatic disease, but it may occur in patients with non-hepatic hyperammonemia (NHH). But, studies on the prognosis and possible risk factors of this disorder are lacking. The aim of this study was to find possible prognostic and risk factors for NHH in critically ill patients. Methods: Data were extracted from MIMIC III Database. Survival was analyzed by the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify prognostic factors. Results: Valproic acid, carbamazepine, corticosteroids, recent orthopedic surgery, epilepsy, disorders of urea cycle metabolism, and obesity were found to be risk factors for NHH. Patients in the hyperammonemia group had a higher 30 day mortality than those in the non-hyperammonemia group. After final regression analysis, ammonia was found to be independent predictors of mortality. Conclusion: Ammonia was an independent prognostic predictor of 30 day mortality for critical care patients without liver disease.

Keywords: ammonia; hyperammonemia; non-hepatic; prognosis prediction; risk factor.