Serum Ammonia Levels Might Predict Severity of Hepatic Encephalopathy and Mortality

Although ammonia is thought to play an important role in the pathogenesis of hepatic encephalopathy (HE) in patients with cirrhosis, its clinical utility traditionally has been limited to diagnostics. To evaluate whether a higher ammonia level is associated with greater severity of HE and worse outcomes, researchers analyzed prospectively collected data from three different cohorts totaling 500 hospitalized patients with cirrhosis. Plasma ammonia levels were measured on admission. During follow-up, organ failures and 28-day mortality were documented. Results were as follows:

• Ammonia level was significantly correlated with severity of HE (mean ammonia levels by HE grade: grade 3–4, 97 µmol/L; grade 2, 77 µmol/L; grade 0–1, 73 µmol/L).

• The 28-d…