Clinical Trials Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2020; 26(45): 7222-7231
Published online Dec 7, 2020. doi: 10.3748/wjg.v26.i45.7222
Relationship between the incidence of non-hepatic hyperammonemia and the prognosis of patients in the intensive care unit
Zhi-Peng Yao, Yue Li, Yang Liu, Hong-Liang Wang
Zhi-Peng Yao, Yue Li, Yang Liu, Hong-Liang Wang, Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
Author contributions: Yao ZP, Li Y, Liu Y and Wang HL designed the research, and performed the research; Yao ZP analyzed the data; Yao ZP and Li Y wrote the paper.
Supported by Scientific research project of Heilongjiang Health and Family Planning Commission, No. 2019045.
Institutional review board statement: The study was approved by The Ethics Committee of The Second Affiliated Hospital of Harbin Medicine University (Nangang, China).
Clinical trial registration statement: This study is registered at Chinese Clinical Trial Register (ChiCTR), registration No. ChiCTR1900026632.
Informed consent statement: All patients in our study provided informed consent.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Liang Wang, MD, PhD, Full Professor, Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin 150001, Heilongjiang Province, China. icuwanghongliang@163.com
Received: September 1, 2020
Peer-review started: September 1, 2020
First decision: September 30, 2020
Revised: October 14, 2020
Accepted: October 27, 2020
Article in press: October 14, 2020
Published online: December 7, 2020
Abstract
BACKGROUND

Ammonia is a normal constituent of body fluids and is found mainly through the formation of urea in the liver. Blood levels of ammonia must remain low as even slightly elevated concentrations (hyperammonemia) are toxic to the central nervous system.

AIM

To examine the relationship between the incidence of non-hepatic hype-rammonemia (NHH) and the prognosis of patients who were admitted to the intensive care unit (ICU).

METHODS

This is a prospective, observational and single-center study. A total of 364 patients who were admitted to the ICU from November 2019 to February 2020 were initially enrolled. Changes in the levels of blood ammonia at the time of ICU admission and after ICU admission were continuously monitored. In addition, factors influencing the prognosis of NHH patients were analyzed.

RESULTS

A total of 204 patients who met the inclusion criteria were enrolled in this study, including 155 NHH patients and 44 severe-NHH patients. The incidence of NHH and severe-NHH was 75.98% and 21.57%, respectively. Patients with severe-NHH exhibited longer length of ICU stay and higher Acute Physiologic Assessment and Chronic Health Evaluation and Sequential Organ Failure Assessment scores compared to those with mild-NHH and non-NHH. Glasgow Coma Scale scores of patients with severe-NHH were than those of non-NHH patients. In addition, the mean and initial levels of ammonia in the blood might be helpful in predicting the prognosis of NHH.

CONCLUSION

High blood ammonia level is frequent among NHH patients admitted to the ICU, which is related to the clinical characteristics of patients. Furthermore, the level of blood ammonia may be helpful for prognosis prediction.

Keywords: Non-hepatic hyperammonemia, Intestinal absorption, Blood ammonia level, Metabolism of amino acid, Severe patients, Intensive care unit

Core Tip: Ammonia is a normal constituent of body fluids, and the concentration of blood ammonia must remain low. Herein, a prospective and single-center study was conducted to investigate the relationship between the incidence of non-hepatic hyperammonemia and the prognosis of patients admitted to the intensive care unit. Furthermore, the level of blood ammonia may be helpful for prognosis prediction of critically ill patients.