ArticleQJM : monthly journal of the Association of Physicians2023
A modified Child-Turcotte-Pugh score based on plasma ammonia predicts survival for patients with decompensated cirrhosis.
Article in QJM : monthly journal of the Association of Physicians, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.
- Effect of adipose-related parameters on mortality in patients with liver cirrhosis: a meta-analysis.Annals of medicine · 2025Pooled it
- [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
- Visceral to subcutaneous fat area ratio as a novel prognostic biomarker in cirrhosis patients undergoing TIPS: a retrospective study.Frontiers in medicine · 2026Article
- Association between red cell distribution width-to-albumin ratio and all-cause mortality in critically ill cirrhotic patients with sepsis: a retrospective analysis of the MIMIC-IV database.Frontiers in medicine · 2025Article
- Development and validation of a machine learning-based model to predict survival in patients with cirrhosis after transjugular intrahepatic portosystemic shunt.EClinicalMedicine · 2025Article
- Clinical Utility of the Trajectory of Serum Bilirubin and International Normalized Ratio Values in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure.International journal of general medicine · 2025Article
- Artificial intelligence-based evaluation of prognosis in cirrhosis.Journal of translational medicine · 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
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10 authors at 1 institution in 1 country.
Funding
Abstract
backgroundPlasma ammonia has been shown to be an independent prognostic factor for patients with liver cirrhosis.
aimWe aimed to investigate the discrimination and calibration of a new prognostic model (aCTP) based on plasma ammonia (Amm) replacing hepatic encephalopathy (HE) in the Child-Turcotte-Pugh (CTP) score.
designDiagnostic test, paired design.
methodsBaseline Amm levels were corrected to the upper limit of normal (Amm-ULN). We designed the new model based on the cut-off value of Amm-ULN in the observational cohort of 554 clinically stable cirrhotic patients from January 2012 to July 2019. External validation was carried out using prospective data from 185 patients with liver cirrhosis.
resultsOur analysis showed that each 1-point increase in Amm-ULN was associated with a 2-fold increase in the likelihood of mortality [hazard ratio (HR), 2.06; 95% CI: 1.81-2.36, P < 0.001]. In the aCTP score, Amm-ULN < 1.0 was defined as a score of 1, 1.0 ≤ Amm-ULN < 1.4 as 2 and ≥1.4 as 3. The survival curves among three aCTP grades were significantly different (P < 0.0001). The aCTP score showed the better agreements between predicted and observed events in the validating cohorts than the CTP score (C-statistics: 0.75 and 0.69, P < 0.001). The aCTP score showed inspiring power to predict acute decompensation (C-statistics: 0.76; 95% CI: 0.71-0.81) and acute-on-chronic liver failure (C-statistics: 0.81; 95% CI: 0.77-0.86).
conclusionThis study demonstrates the feasibility and the potential for plasma Amm replacing HE (aCTP) to enhance the prognostication of transplant-free survival provided by the CTP score for patients with decompensated cirrhosis.
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