Regular articleCorrelation between ammonia levels and the severity of hepatic encephalopathy☆
Section snippets
Patients
We recruited consecutive patients with cirrhosis who were admitted to our institution between September 1998 and December 1999. Patients were enrolled within 24 hours of admission, regardless of their mental status. A diagnosis of cirrhosis was determined by biopsy (41% [50/121] of patients) or by signs of portal hypertension, such as ascites, gastroesophageal varices, or previous variceal bleeding. We obtained informed consent from each patient or from an immediate family member if the patient
Results
Of the 153 patients whom we approached for the study, 16, including 10 with hepatic encephalopathy, refused to participate. Another 16 patients did not meet inclusion and exclusion criteria (2 did not have cirrhosis, 4 were on hemodialysis, 8 had recently been drinking alcohol, and 2 had altered mental status due to causes other than hepatic encephalopathy). The remaining 121 patients were included in the final analysis (Table 2). Their mean (± SD) age was 54 ± 10 years (range, 29 to 75 years).
Discussion
We found a strong correlation between ammonia levels and the severity of hepatic encephalopathy. To overcome some of the limitations of previous studies, we optimized the conditions under which the relation between hepatic encephalopathy and ammonia levels was examined. Ammonia measurement was performed using a newer and more reliable enzymatic method, and grading of encephalopathy was blinded to the ammonia measurements. Under these conditions, ammonia levels correlated strongly with the
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This study was supported by a research grant from the American College of Gastroenterology, Arlington, Virginia.