Published online Dec 7, 2020. doi: 10.3748/wjg.v26.i45.7222
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
Ammonia is a normal constituent of body fluids, and the concentration of blood ammonia must remain low.
Ammonia is a normal constituent of body fluids and is treated 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.
The aim of this study was to determine the relationship between the incidence of non-hepatic hyperammonemia (NHH) and the prognosis of patients who were admitted to the intensive care unit (ICU).
This is a prospective, observational and single-center study. A total of 204 patients who were admitted to ICU from November 2019 to February 2020 were finally 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.
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 a 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 lower 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.
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.
It is necessary to explore the relationship between the incidence of NHH and the prognosis of patients in the ICU. Early intervention and treatment may be the key to improving the prognosis of critically ill patients, a hypothesis that needs to be confirmed by further studies in the future.