Evidence map›Paper›PMID 39016195›Full record

Observational studyLiver international : official journal of the International Association for the Study of the Liver2024

Ammonia and urea metabolism in acute liver failure: A multicentre cohort study.

Filipe S Cardoso, David Toapanta, Natalia Jimenez, Pedro Fidalgo, António Figueiredo, Miriam Valdivieso, Nuno Germano, Jody A Rule, William M Lee, Juan G Abraldes and 2 more

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Liver international : official journal of the International Association for the Study of the Liver, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. The role of ammonia in chronic liver disease.Hepatology communications · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Filipe S CardosoTransplant Unit, Intensive Care Unit, Nova Medical School, Curry Cabral Hospital, Lisbon, Portugal.ORCID 0000-0002-6221-6435
David ToapantaLiver ICU, Liver Unit, Clinic Hospital, Barcelona, Spain.
Natalia JimenezLiver ICU, Liver Unit, Clinic Hospital, Barcelona, Spain.ORCID 0000-0003-3376-9660
Pedro FidalgoIntensive Care Unit, São Francisco Xavier Hospital, Lisbon, Portugal.
António FigueiredoPathological Anatomy Department, Curry Cabral Hospital, Lisbon, Portugal.
Miriam ValdiviesoLiver ICU, Liver Unit, Clinic Hospital, Barcelona, Spain.
Nuno GermanoIntensive Care Unit, Curry Cabral Hospital, Lisbon, Portugal.
Jody A RuleDepartment of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.ORCID 0000-0002-4019-372X
William M LeeDepartment of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.ORCID 0000-0002-2783-5441
Juan G AbraldesLiver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada.ORCID 0000-0003-3421-937X
Enric ReverterLiver ICU, Liver Unit, Clinic Hospital, Barcelona, Spain.ORCID 0000-0002-4967-6947
Constantine J KarvellasLiver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada.

Funding

A Multi-Center Study of Acute Liver Failure in AdultsU01DK058369 · NIDDK · UT SOUTHWESTERN MEDICAL CENTER · PI DURKALSKI, VALERIE L, FONTANA, ROBERT J · 2005 to 2019
$27.4M
A MULTI-CENTER THERAPY TRIAL FOR ACUTE LIVER FAILURER01DK058369 · NIDDK · UNIVERSITY OF TEXAS SW MED CTR/DALLAS · PI LEE, WILLIAM M · 2000 to 2004
$4.2M
NIDDK NIH HHS R01 DK058369NIDDK NIH HHS U01 DK058369NIH HHS U-01 58369
6 · The paper itself

Abstract

BACKGROUND &

aimsAmmonia is metabolized into urea in the liver. In acute liver failure (ALF), ammonia has been associated with survival. However, urea variation has been poorly studied.

methodsObservational cohort including ALF patients from Curry Cabral Hospital (Lisbon, Portugal) and Clinic Hospital (Barcelona, Spain) between 10/2010 and 01/2023. The United States ALF Study Group cohort was used for external validation. Primary exposures were serum ammonia and urea on ICU admission. Primary endpoint was 30-day transplant-free survival (TFS). Secondary endpoint was explanted liver weight.

resultsAmong 191 ALF patients, median (IQR) age was 46 (32; 57) years and 85 (44.5%) were males. Overall, 86 (45.0%) patients were transplanted and 75 (39.3%) died. Among all ALF patients, following adjustment for age, sex, body weight, and aetiology, higher ammonia or lower urea was independently associated with higher INR on ICU admission (p < .009). Among all ALF patients, following adjustment for sex, aetiology, and lactate, higher ammonia was independently associated with lower TFS (adjusted odds ratio (95% confidence interval [CI]) = 0.991 (0.985; 0.997); p = .004). This model predicted TFS with good discrimination (area under receiver operating curve [95% CI] = 0.78 [0.75; 0.82]) and reasonable calibration (R

conclusionsAmong ALF patients, serum ammonia and urea were associated with ALF severity. A score incorporating serum ammonia predicted TFS reasonably well.

Indexed as

AmmoniaLiver Failure, AcuteUreaAdultCohort StudiesFemaleHumansLiverLiver TransplantationMaleMiddle AgedPortugalROC CurveSpainAmmoniaUreahepatitisliver regenerationnecrosisnitrogenoutcomestransplant

Identifiers

PMID39016195
PMCPMC11610480

What OpenQuestion holds

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Registered trials

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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.