ArticleHepatology international2021
Dynamic assessments of hepatic encephalopathy and ammonia levels predict mortality in acute-on-chronic liver failure.
Article in Hepatology international, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed, 48 citations in OpenAlex.
- Hepatic Encephalopathy Severity and Mortality Risk Stratification in Alcohol-Related Acute-on-Chronic Liver Failure.Diagnostics (Basel, Switzerland) · 2026Article
- Acute-on-chronic liver failure: pathophysiological mechanisms and clinical management.Nature reviews. Gastroenterology & hepatology · 2026Review
- 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
- [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
- A Prognostic Model Based on Immune-Inflammatory-Nutritional Indicators for 28-Day Mortality in Sepsis Patients with Acute-on-Chronic Liver Failure.Journal of inflammation research · 2026Article
- Transparent and dynamic network-based risk assessment for development of hepatic encephalopathy.Communications medicine · 2025Article
- Predicting prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure from longitudinal ultrasound images using a multi-task deep learning approach.Annals of medicine · 2025Article
- Comparing efficacy of different scoring models to predict hepatic encephalopathy after TIPS in cirrhotic patients.Annals of medicine · 2025Article
- Hepatic encephalopathy in cirrhosis: therapies and developments.Metabolic brain disease · 2025Review
- Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia.Hepatology international · 2025Review
- Down the road towards hepatic encephalopathy. The elusive ammonia- what determines the arterial concentration?Metabolic brain disease · 2024Review
- Construction of a prediction model for hepatic encephalopathy in acute-on-chronic liver failure patients.Annals of medicine · 2024Article
- Hepatic encephalopathy post-TIPS: Current status and prospects in predictive assessment.Computational and structural biotechnology journal · 2024Review
- Ammonia-induced stress response in liver disease progression and hepatic encephalopathy.Nature reviews. Gastroenterology & hepatology · 2024Review
- Development and Validation of a New Prognostic Model for Predicting Survival Outcomes in Patients with Acute-on-chronic Liver Failure.Journal of clinical and translational hepatology · 2024Article
- The Value of Ammonia as a Biomarker in Patients with Cirrhosis.Seminars in liver disease · 2024Review
- Ammonia is associated with liver-related complications and predicts mortality in acute-on-chronic liver failure patients.Scientific reports · 2024Article
- Progress on clinical prognosis assessment in liver failure.Liver research (Beijing, China) · 2023Review
- A novel nomogram to predict 90-day mortality in patients with hepatitis B virus-related acute-on-chronic liver failure: a single-center retrospective study.BMC gastroenterology · 2023Article
- Serum ammonia variation predicts mortality in patients with hepatitis B virus-related acute-on-chronic liver failure.Frontiers in microbiology · 2023Article
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Authors and funding
45 authors at 20 institutions in 11 countries.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundWe evaluated the dynamics of hepatic encephalopathy (HE) and ammonia estimation in acute-on-chronic liver failure (ACLF) patients due to a paucity of evidence.
methodsACLF patients recruited from the APASL-ACLF Research Consortium (AARC) were followed up till 30 days, death or transplantation, whichever earlier. Clinical details, including dynamic grades of HE and laboratory data, including ammonia levels, were serially noted.
resultsOf the 3009 ACLF patients, 1315 (43.7%) had HE at presentation; grades I-II in 981 (74.6%) and grades III-IV in 334 (25.4%) patients. The independent predictors of HE at baseline were higher age, systemic inflammatory response, elevated ammonia levels, serum protein, sepsis and MELD score (p < 0.05; each). The progressive course of HE was noted in 10.0% of patients without HE and 8.2% of patients with HE at baseline, respectively. Independent predictors of progressive course of HE were AARC score (≥ 9) and ammonia levels (≥ 85 μmol/L) (p < 0.05; each) at baseline. A final grade of HE was achieved within 7 days in 70% of patients and those with final grades III-IV had the worst survival (8.9%). Ammonia levels were a significant predictor of HE occurrence, higher HE grades and 30-day mortality (p < 0.05; each). The dynamic increase in the ammonia levels over 7 days could predict nonsurvivors and progression of HE (p < 0.05; each). Ammonia, HE grade, SIRS, bilirubin, INR, creatinine, lactate and age were the independent predictors of 30-day mortality in ACLF patients.
conclusionsHE in ACLF is common and is associated with systemic inflammation, poor liver functions and high disease severity. Ammonia levels are associated with the presence, severity, progression of HE and mortality in ACLF patients.
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