Serum ammonium levels and clinical significance in patients with non-hepatic disease

Abstract

Background: Hyperammonemia lead to a deepening of coma due to liver failure. Multiple studies have illustrated serum ammonium levels increased during cases of coma, convulsions, seizures, and severe trauma.1 Studies have shown that when serum ammonium levels are significantly elevated, treatment results are better if the ammonium level is rapidly reduced during treatment.15 Therefore, the aim of this study is to determine the serum ammonium level in critical illness with non-hepatic disease and determine whether it can be used in therapeutic strategies. Aim: To investigate the effect of serum ammonia levels on the clinical severity and prognosis of critically ill patients with non-hepatic disease Materials and Methods: The study was conducted using a hospital-based prospective cohort study design. In this study, we were studied a total of 116 patients who were treated in the Intensive Care Unit of AfÏliated Hospital of Inner Mongolia Minzu University from October 1st to December 31st, 2023. According to criteria a total 116 cases divided by clinical severity and prognosis that were compared with also the serum ammonium level and other tests. Results: A total of 116 cases were compared according to severity at the time of arrival to hospital, and 9.4% were moderate, 45.6% were severe, and 45% were critical ill patients. There were no significant differences in mean age (p=0.53), age group (p=0.53), or gender (p=0.79). As for underlying disease, the incidence of pneumonia (p=0.021) and cardiac arrest (p=0.004) was higher in the critical ill group. Also, the mean level of pH (7.42 vs 7.39 vs 7.33, p=0.01), lactate (1.21 vs 1.36 vs 3.28, p<0.001), and serum ammonium (33.92 vs 74.28 vs 98.51, p<0.001) was compared between the 3 groups and there was statistically significant difference. Then, all cases were divided into 2 groups: alive (75.9%) and dead (24.1%), the mean level of serum ammonium at the time of hospital admission (69.74 vs 111.11, p<0.001) was higher in the dead group. A ROC analysis was performed comparing the mortality risk with serum ammonium level at the time of hospital admission (AUC 0.710, 95% CI, 0.7-0.41, cut-off value 70 mmol/L, p<0.001). A serum ammonium level ≥70 mmol/L at hospital admission were independent risk factor of mortality level (OR-0.32, p=0.015), lactate level (OR-1.7, p=0.006), and SOFA score (OR-1.72, p=0.013). Conclusions: 1. Deteriorating patients clinical condition and severity were correlated with serum ammonium level becomes higher, such us ammonium is 33.92 mmol/L in moderate cases, 74.28 mmol/L severe cases, 98.51 mmol/L critically ill cases. 2. A serum ammonia level of ≥70 mmol/L at the time of hospital admission is independent risk factor of increased mortality.