Observational studyScientific reports2020
Serum ammonia is a strong prognostic factor for patients with acute-on-chronic liver failure.
Observational study in Scientific reports, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 47 citations in OpenAlex.
- Probiotics are beneficial for liver cirrhosis: a systematic review and meta-analysis of randomized control trials.Frontiers in medicine · 2024Pooled it
- The role of ammonia in chronic liver disease.Hepatology communications · 2026Review
- [Clinical analysis of blood ammonia levels for predicting survival following transjugular intrahepatic portosystemic shunt in patients with cirrhosis].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 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
- Anxiety is a risk prognosis factor for hepatocellular carcinoma with portal vein tumor thrombus who underwent hepatic arterial infusion chemotherapy: a propensity score-matching cohort study.World journal of surgical oncology · 2025Article
- Hepatitis A and E Viruses Are Important Agents of Acute Severe Hepatitis in Asia: A Narrative Review.Pathogens (Basel, Switzerland) · 2025Review
- Hyperammonemia induces programmed liver cell death.Science advances · 2025Article
- Development and validation of a machine learning-based model to predict survival in patients with cirrhosis after transjugular intrahepatic portosystemic shunt.EClinicalMedicine · 2025Article
- Down the road towards hepatic encephalopathy. The elusive ammonia- what determines the arterial concentration?Metabolic brain disease · 2024Review
- Early prediction of acute-on-chronic liver failure development in patients with diverse chronic liver diseases.Scientific reports · 2024Article
- Ammonia-induced stress response in liver disease progression and hepatic encephalopathy.Nature reviews. Gastroenterology & hepatology · 2024Review
- The Value of Ammonia as a Biomarker in Patients with Cirrhosis.Seminars in liver disease · 2024Review
- External validation of the modified CTP score based on ammonia to predict survival in patients with cirrhosis after TIPS placement.Scientific reports · 2024Article
- Ammonia is associated with liver-related complications and predicts mortality in acute-on-chronic liver failure patients.Scientific reports · 2024Article
- Three Artificial Liver Models of Treatment of Acute-on-Chronic Liver Failure.Therapeutics and clinical risk management · 2024Article
- Prognostic value of serum ammonia in critical patients with non-hepatic disease: A prospective, observational, multicenter study.Journal of translational internal medicine · 2023Article
- Protective effects of peanut skin extract on high-fat and high-fructose diet-induced kidney injury in rats.Food science and biotechnology · 2023Article
- Serum ammonia variation predicts mortality in patients with hepatitis B virus-related acute-on-chronic liver failure.Frontiers in microbiology · 2023Article
- Differentiation of hepatic encephalopathy from delirium tremens: A case series and review.Industrial psychiatry journal · 2021Article
- Role of ammonia in predicting the outcome of patients with acute-on-chronic liver failure.World journal of clinical cases · 2021Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Ammonia is thought to be central to the pathogenesis of hepatic encephalopathy (HE), but its prognostic role in acute-on-chronic liver failure (ACLF) is still unknown. We aimed to determine the association between serum ammonia level and short-term prognosis in ACLF. Furthermore, we performed an in-depth evaluation of the independent effect of serum ammonia level on the short-term prognosis of hepatitis B virus (HBV) reactivation-induced ACLF patients. We identified 174 patients as part of prospective observational studies in patients with ACLF. Plasma ammonia levels were measured on admission, and several prognostic scores were used to determine the prognostic effect of ammonia. The 28-day patient survival was determined. Receiver operating characteristic analysis was used to identify the cut-off points for ammonia values, and multivariable analysis was performed using the Cox proportional hazard regression model. Plasma ammonia was significantly higher in nonsurvivors (83.53 ± 43.78 versus 67.13 ± 41.77 µmol/L, P = 0.013), and ACLF patients with hyperammonemia had significantly higher 28-day mortality than those without hyperammonemia. Ammonia was also closely related to ACLF grade (P < 0.001) and organ failure, including liver (P = 0.048), coagulation (P < 0.001) and brain (P < 0.001). HBV reactivation serves as the main precipitating factor in the ACLF population. Subgroup analysis showed that ammonia is also a strong prognostic factor in the HBV reactivation-induced ACLF population. Ammonia level is closely correlated with failure of other organs and is an independent risk factor for mortality in ACLF and the special population defined as HBV reactivation-related ACLF. Based on the results from our study, we measured serum ammonia in the population with ACLF, which strongly indicates their prognosis. It serves as an important biomarker and a therapeutic target.
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