Ammonia is associated with liver-related complications and predicts mortality in acute-on-chronic liver failure patients

Kessarin Thanapirom, Sombat Treeprasertsuk, Ashok Choudhury, Nipun Verma, Radha Krishan Dhiman, Mamun Al Mahtab, Harshad Devarbhavi, Akash Shukla, Saeed Sadiq Hamid, Wasim Jafri, Soek Siam Tan, Guan H. Lee, Hasmik Ghazinyan, Ajit Sood, Dong Joon Kim, C. E. Eapen, Han Tao, Nan Yuemin, A. Kadir Dokmeci, Manoj SahuAnil Arora, Ashish Kumar, Ramesh Kumar, V. G.Mohan Prasad, Ananta Shresta, Jose Sollano, Diana Alcantara Payawal, George Lau, Shiv Kumar Sarin

Research output: Contribution to journalArticlepeer-review


The relationship between ammonia and liver-related complications (LRCs) in acute-on-chronic liver failure (ACLF) patients is not clearly established. This study aimed to evaluate the association between ammonia levels and LRCs in patients with ACLF. The study also evaluated the ability of ammonia in predicting mortality and progression of LRCs. The study prospectively recruited ACLF patients based on the APASL definition from the ACLF Research Consortium (AARC) from 2009 to 2019. LRCs were a composite endpoint of bacterial infection, overt hepatic encephalopathy (HE), and ascites. A total of 3871 cases were screened. Of these, 701 ACLF patients were enrolled. Patients with LRCs had significantly higher ammonia levels than those without. Ammonia was significantly higher in patients with overt HE and ascites, but not in those with bacterial infection. Multivariate analysis found that ammonia was associated with LRCs. Additionally, baseline arterial ammonia was an independent predictor of 30-day mortality, but it was not associated with the development of new LRCs within 30 days. In summary, baseline arterial ammonia levels are associated with 30-day mortality and LRCs, mainly overt HE and ascites in ACLF patients.

Original languageEnglish
Article number5796
JournalScientific Reports
Issue number1
Publication statusPublished - Dec 2024


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