Observational studyCritical care medicine2018
Features of Adult Hyperammonemia Not Due to Liver Failure in the ICU.
Observational study in Critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 1 synthesis or guideline pooled it, 77 citations in OpenAlex.
- The urea-to-creatinine ratio as an emerging biomarker in critical care: a scoping review and meta-analysis.Critical care (London, England) · 2025Pooled it
- Relationship between the incidence of non-hepatic hyperammonemia and the prognosis of patients in the intensive care unit.World journal of gastroenterology · 2020Trial
- Fulminant hyperammonemia during intensive chemotherapy in the setting of previously unrecognized partial ornithine transcarbamylase deficiency.International journal of hematology · 2026Article
- Systemic Ammonia Toxicity: An Underestimated Driver of Cerebral Energy Crisis in Hepatic Encephalopathy.International journal of molecular sciences · 2026Review
- Article
- Severe hyperammonemia following coronary artery bypass grafting.Journal of cardiothoracic surgery · 2026Article
- Hypoaminoacidemia and Pyroglutamic Aciduria: Potential Biomarkers in Malnutrition-Related Hyperammonemia.JIMD reports · 2026Article
- Establishment of an Inferred Reference Range for Blood Ammonia in Dogs and Cats Using a Point-of-Care Assay.Veterinary sciences · 2025Article
- Age-Related Meat Flavor Precursors of Naturally Grazed Sunit Sheep: Metabolomics and Transcriptomics Approaches.Foods (Basel, Switzerland) · 2025Article
- Severe anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor encephalitis with prolonged hyperammonemia: a case report.BMC neurology · 2025Article
- Diverting the Diagnosis: A Case Report of Hemodialysis Masking the Etiology of Hyperammonemia.Canadian journal of kidney health and disease · 2025Article
- A Young Man with Late-onset Ornithine Transcarbamylase Deficiency Successfully Treated with Prompt and Intensive Blood Purification Therapy for Severe Hyperammonemic Encephalopathy.Internal medicine (Tokyo, Japan) · 2025Article
- Recurrent hyperammonemic encephalopathy in a breast cancer patient receiving capecitabine therapy: a case report and literature review.Frontiers in pharmacology · 2025Article
- Hyperammonaemic encephalopathy due to non-functioning urea cycle as a complication to gastric bypass surgery.Metabolic brain disease · 2024Article
- NHH promotes Sepsis-associated Encephalopathy with the expression of AQP4 in astrocytes through the gut-brain Axis.Journal of neuroinflammation · 2024Article
- L-Isoleucine reverses hyperammonemia-induced myotube mitochondrial dysfunction and post-mitotic senescence.The Journal of nutritional biochemistry · 2024Article
- Prognostic value of serum ammonia in critical patients with non-hepatic disease: A prospective, observational, multicenter study.Journal of translational internal medicine · 2023Article
- Treatment of Hyperammonemia Syndrome in Lung Transplant Recipients.Journal of clinical medicine · 2023Review
- Coma With Hyperammonemia in a Patient With Kwashiorkor.Gastroenterology research · 2023Article
- Relationship between Nonhepatic Serum Ammonia Levels and Sepsis-Associated Encephalopathy: A Retrospective Cohort Study.Emergency medicine international · 2023Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
Abstract
objectivesTo evaluate the epidemiology of hyperammonemia unrelated to liver failure in the critical care setting.
designRetrospective case series.
settingCritically ill patients admitted to ICUs at Mayo Clinic, Rochester, MN (medical ICU, two mixed medical-surgical ICUs, coronary care unit, or the cardiosurgical ICU) between July 1, 2004, and October 31, 2015. PATIENTS: Adult critically ill patients with hyperammonemia not related to acute or chronic liver failure. We excluded patients with diagnosis of moderate or severe liver disease, hyperbilirubinemia, and patients who denied the use of their medical records.
interventionsNone. MEASUREMENTS AND MAIN
resultsOf 3,908 ICU patients with hyperammonemia, 167 (4.5%) had no evidence of acute or chronic liver failure. One-hundred one patients (60.5%) were male with median age of 65.7 years (interquartile range, 50-74.5 yr) and median serum ammonia level of 68 µg/dL (interquartile range, 58-87 µg/dL). Acute encephalopathy was present in 119 patients (71%). Predisposing conditions included malnutrition 27 (16%), gastric bypass six (3.6%), total parenteral nutrition four (2.4%); exposure to valproic acid 17 (10%); status epilepticus 11 (6.6%), high tumour burden 19 (11.3%), and renal failure 82 (49.1%). Urea cycle defects were diagnosed in seven patients (4.1%). Hospital mortality was high (30%), and median ammonia level was higher among the nonsurvivors (74 vs 67 µg/dL; p = 0.05). Deaths were more likely in hyperammonemic patients who were older (p = 0.016), had greater illness severity (higher Acute Physiology and Chronic Health Evaluation III score, p < 0.01), malignancy (p < 0.01), and solid organ transplantation (p = 0.04), whereas seizure disorder was more common in survivors (p = 0.02). After adjustment, serum ammonia level was not associated with increased mortality.
conclusionsHyperammonemia occurs in a substantial minority of critically ill patients without liver failure. These patients have a poor prognosis, although ammonia level per se is not independently associated with mortality. Serum ammonia should be measured when risk factors are present, such as nutritional deficiencies and protein refeeding, treatment with valproic acid, high tumour burden, and known or suspected urea cycle abnormalities.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.