ArticleHepatology communications2026
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.
Article in Hepatology communications, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPredicting liver-related events (LREs) in stable cirrhosis is crucial; however, traditional scoring methods perform poorly. Ammonia, due to its pathophysiological integration, may prognosticate LRE. This study tests the hypothesis that hyperammonemia can predict LRE and evaluates the AMMON-OHE score in a prospective cohort.
methodsA total of 280 patients with cirrhosis were prospectively enrolled and followed until LRE, liver transplant, or death. Ammonia was measured at enrollment and periodically, along with other parameters. LRE at 1 year was defined as hospitalization for ascites, variceal bleeding, hepatic encephalopathy, or bacterial infection. AMN ≥ULN was calculated by adjusting ammonia to the lab's upper normal limit. Cox regression and time-dependent analyses were performed. AMMON-OHE was validated using TRIPOD+AI and decision curve analysis.
resultsMost patients were male (60.7%), with a mean age of 66.1±10.3 years. MASLD was the commonest etiology (43.7%). Median CTP and MELD scores were 6 (IQR: 5-7) and 8 (IQR: 6-11). Overall, 60 (21.4%) developed LRE at 1 year, and 23 (8.2%) died. In multivariable analysis, AMN ≥ULN was an independent predictor of LRE (HR: 4.92; 95% CI: 2.80-8.64). The AMMON-OHE score predicted LRE with a time-dependent AUROC of 0.859 (CI: 0.810-0.907), outperforming MELD (p=0.014) but similar to CTP (p=NS). The AMMON-OHE score underestimated the risk of LRE in our cohort.
conclusionsAMN ≥ULN in stable outpatients with cirrhosis can predict LRE. Although the AMMON-OHE score has a high AUROC, it underestimates the risk of LRE in this cohort.
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