ArticleBMC gastroenterology2009
Blood ammonia levels in liver cirrhosis: a clue for the presence of portosystemic collateral veins.
Article in BMC gastroenterology, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 2 of them syntheses that pooled it.
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Who cites it
57 citing papers in PubMed, 2 syntheses or guidelines pooled it, 102 citations in OpenAlex.
- Platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis.The Cochrane database of systematic reviews · 2017Pooled it
- Performance of platelet count/spleen diameter ratio for diagnosis of esophageal varices in cirrhosis: a meta-analysis.Digestive diseases and sciences · 2012Pooled it
- Etomidate and mortality in cirrhotic patients with septic shock.BMC clinical pharmacology · 2011Trial
- Revisiting gut microbiota-driven ammonia metabolism: from disease burden to physiological adaptation.Gut microbes · 2026Review
- Systemic Ammonia Toxicity: An Underestimated Driver of Cerebral Energy Crisis in Hepatic Encephalopathy.International journal of molecular sciences · 2026Review
- The predictive role of ammonia in liver-related decompensation and mortality in patients with compensated cirrhosis: A retrospective cohort study.Canadian liver journal · 2026Article
- Hyperammonemia predicts the development of liver-related events in a prospective cohort of stable cirrhosis patients and the external validation of the AMMON-OHE score.Hepatology communications · 2026Article
- Ammonia-to-Urea Ratio: A Noninvasive First-Line Tool for Detecting Clinically Significant Portal Hypertension.JGH open : an open access journal of gastroenterology and hepatology · 2025Article
- Down the road towards hepatic encephalopathy. The elusive ammonia- what determines the arterial concentration?Metabolic brain disease · 2024Review
- Serum immunoglobulin A levels: Diagnostic utility in alcoholic liver disease and association with liver fibrosis in steatotic liver disease.Biomedical reports · 2024Article
- Association Between Bowel Wall Thickening and Long-Term Outcomes in Decompensated Liver Cirrhosis.Advances in therapy · 2024Article
- ADAMTS-13: A Prognostic Biomarker for Portal Vein Thrombosis in Japanese Patients with Liver Cirrhosis.International journal of molecular sciences · 2024Article
- Article
- Human Albumin Infusion for the Management of Liver Cirrhosis and Its Complications: An Overview of Major Findings from Meta-analyses.Advances in therapy · 2023Article
- Coagulation Dysfunction in Patients with Liver Cirrhosis and Splenomegaly and Its Countermeasures: A Retrospective Study of 1522 Patients.Disease markers · 2023Article
- A review of wearable biosensors for sweat analysis.Biomedical engineering letters · 2021Review
- Lights and Shadows in Hepatic Encephalopathy Diagnosis.Journal of clinical medicine · 2021Review
- Clinical implications of thoracic duct dilatation in patients with chronic liver disease.Medicine · 2020Observational
- Changing Patterns of Hepatocellular Carcinoma after Treatment with Direct Antiviral Agents.Gastrointestinal tumors · 2020Article
- Aspirin and the risk of hepatocellular carcinoma development in patients with alcoholic cirrhosis.Medicine · 2020Observational
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPortal hypertension leads to the formation of portosystemic collateral veins in liver cirrhosis. The resulting shunting is responsible for the development of portosystemic encephalopathy. Although ammonia plays a certain role in determining portosystemic encephalopathy, the venous ammonia level has not been found to correlate with the presence or severity of this entity. So, it has become partially obsolete. Realizing the need for non-invasive markers mirroring the presence of esophageal varices in order to reduce the number of endoscopy screening, we came back to determine whether there was a correlation between blood ammonia concentrations and the detection of portosystemic collateral veins, also evaluating splenomegaly, hypersplenism (thrombocytopenia) and the severity of liver cirrhosis.
methodsOne hundred and fifty three consecutive patients with hepatic cirrhosis of various etiologies were recruited to participate in endoscopic and ultrasonography screening for the presence of portosystemic collaterals mostly esophageal varices, but also portal hypertensive gastropathy and large spontaneous shunts.
resultsBased on Child-Pugh classification, the median level of blood ammonia was 45 mcM/L in 64 patients belonging to class A, 66 mcM/L in 66 patients of class B and 108 mcM/L in 23 patients of class C respectively (p < 0.001).The grade of esophageal varices was concordant with venous ammonia levels (rho 0.43, p < 0.001). The best area under the curve was given by ammonia concentrations, i, e., 0.78, when comparing areas of ammonia levels, platelet count and spleen longitudinal diameter at ultrasonography. Ammonia levels predicted hepatic decompensation and ascites presence (Odds Ratio 1.018, p < 0.001).
conclusionIdentifying cirrhotic patients with high blood ammonia concentrations could be clinically useful, as high levels would lead to suspicion of being in presence of collaterals, in clinical practice of esophageal varices, and pinpoint those patients requiring closer follow-up and endoscopic screening.
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