Impact of ammonia levels on outcome in clinically stable outpatients with advanced chronic liver disease.

Lorenz Balcar,Julia Krawanja,Bernhard Scheiner,Rafael Paternostro,Benedikt Simbrunner,Georg Semmler,Mathias Jachs,Lukas Hartl,Albert Friedrich Stättermayer,Philipp Schwabl,Matthias Pinter,Thomas Szekeres,Michael Trauner,Thomas Reiberger,Mattias Mandorfer

JHEP reports : innovation in hepatology（2023）

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摘要

A recent landmark study linked ammonia levels (a simple blood test) with hospitalisation/death in individuals with clinically stable cirrhosis. Our study extends the prognostic value of venous ammonia to other important liver-related complications. Although venous ammonia is linked with several key disease-driving mechanisms, they do not fully explain its prognostic value. This supports the concept of direct ammonia toxicity and ammonia-lowering drugs as disease-modifying treatment.

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关键词

ACLD, advanced chronic liver disease,ACLF, acute-on-chronic liver failure,ARLD, alcohol-related liver disease,AUROC, area under the receiver operating characteristic curve,Acute-on-chronic liver failure,BAs, Bile acids,CRP, C-reactive protein,CTP, Child–Turcotte–Pugh score,Cirrhosis,Death,Decompensation,ELF®-test, enhanced liver fibrosis-test,HE, hepatic encephalopathy,HSC, hepatic stellate cell,HVPG, hepatic venous pressure gradient,Hepatic encephalopathy,MAFLD, metabolic-associated fatty liver disease,MAP, mean arterial pressure,NAFLD, non-alcoholic fatty liver disease,NH3-ULN, ammonia-adjusted for the upper limit of normal,PCT, procalcitonin,SHR, subdistribution hazard ratio,UNOS MELD (2016), United Network for Organ Sharing model for end-stage liver disease (2016),aHR, adjusted hazard ratio,vWF, von Willebrand factor

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