Acil Servise Başvuran Hepatik Ensefalopatili Hastaların Amonyak Düzeylerinin Mortaliteye Etkisinin Retrospektif Değerlendirilmesi

Amaç: Hepatik ensefalopati, hepatik yetmezliğe eşlik eden karaciğer metabolizma ürünlerinin birikimi sonucu meydana gelen bilişsel, motor ve davranışsal bozukluktur. Hepatik ensefalopati klinik tablosu, amonyak ve gama aminobütirik asit gibi metabolitlerin birikimi ile karşımıza çıkmaktadır. Çalışmamızda hepatik ensefalopati tanısı konulan hastaların kan amonyak düzeyleri incelenerek mortalite üzerine etkisinin araştırılması amaçlanmıştır.

Anahtar Kelimeler:

Amonyak, Hepatik Ensefalopati, Mortalite

RETROSPECTIVE EVALUATION OF THE EFFECT OF AMMONIA LEVELS ON MORTALITY IN PATIENTS WITH HEPATIC ENCEPHALOPATHY APPLYING TO THE EMERGENCY DEPARTMENT

Objective: Hepatic encephalopathy is a cognitive, motor and behavioral disorder caused by the accumulation of liver metabolism products accompanying hepatic failure. The clinical picture of hepatic encephalopathy appears with the accumulation of metabolites such as ammonia and gamma aminobutyric acid. In our study, we aimed to investigate the effect of blood ammonia levels on mortality in patients diagnosed with hepatic encephalopathy.

Keywords:

Ammonia, Hepatic Encephalopathy, Mortality,

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1. Wijdicks EF. Hepatic encephalopathy. NEJM. 2016;375(17):1660-70.
2. Shalimar, Sheikh MF, Mookerjee RP, Agarwal B, Acharya SK, Jalan R. Prognostic role of ammonia in patients with cirrhosis. Hepatology. 2019;70(3):982-94.
3. Cadranel JF, Lebiez E, Di Martino V, Bernard B, El Koury S, Tourbah A et al. Focal neurological signs in hepatic encephalopathy in cirrhotic patients: an underestimated entity? Am J Gastroenterol. 2001;96(2):515-8.
4. Kantar FU. Approach to elevated liver function tests. Klinik Tıp Bilimleri Dergisi. 2017;5(2):30-8.
5. Kramer L, Tribl B, Gendo A, Zauner C, Schneider B, Ferenci P et al. Partial pressure of ammonia versus ammonia in hepatic encephalopathy. Hepatology (Baltimore, Md). 2000;31(1):30-4.
6. Özatlı D, Haznedaroğlu İC, Büyükaşık Y, Şimşek H. Anemia in chronic liver disease. Türkiye Tıp Dergisi. 1999;6(4):238-45.
7. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35(3):716-21.
8. Maqsood S, Saleem A, Iqbal A, Butt JA. Precipitating factors of hepatic encephalopathy: experience at Pakistan Institute of Medical Sciences Islamabad. JAMC. 2006;18(4):58-62.
9. Vergara-Gomez M, Flavia-Olivella M, Gil-Prades M, Dalmau-Obrador B, Cordoba-Cardona J. Diagnosis and treatment of hepatic encephalopathy in Spain: results of a survey of hepatologists. Gastroenterol Hepatol. 2006;29(1):1-6.
10. Çadırcı K, Cerrah S. Evaluation of precipitating factors in our patients with hepatic encephalopathy. Fırat Med J. 2019;24(2):75-9.
11. Öztürk O, Tuncer İ, Doğanay L, Yorulmaz E, Çolak Y, Enç FY. Factors triggering hepatic encephalopathy in cirrhotic patients. Medeniyet Med J. 2010;25(4):164-8.
12. Saab S. Evaluation of the impact of rehospitalization in the management of hepatic encephalopathy. Int J Gen Med. 2015;5(8):165-73.
13. Pan C, Xu LJ, Zhou R, Zhou W, Huang JR. Multivariate analysis of hepatic encephalopathy occurrence in patients with liver failure. Chinese Journal of Hepatology. 2012;20(6):434-7.
14. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL et al. A model to predict survival in patients with end-stage liver disease. Hepatol. 2001;33(2):464-70.
15. Djiambou-Nganjeu H. Hepatic encephalopathy in liver cirrhosis. J Transl Int Med. 2017;5(1):64-7.
16. Koch DG, Speiser JL, Durkalski V, Fontana RJ, Davern T, McGuire B et al. The natural history of severe acute liver ınjury. Am J Gastroenterol. 2017;112(9):1389-96.
17. Hu X-P, Gao J. International normalized ratio and Model for End-stage Liver Disease score predict short-term outcome in cirrhotic patients after the resolution of hepatic encephalopathy. World J Gastroenterol. 2019;25(26):3426-37.
18. Lee WM, Squires Jr RH, Nyberg SL, Doo E, Hoofnagle JH. Acute liver failure: summary of a workshop. Hepatology. 2008;47(4):1401-15.
19. Hu C, Huang K, Zhao L, Zhang F, Wu Z, Li L. Serum ammonia is a strong prognostic factor for patients with acute-on-chronic liver failure. Sci Rep. 2020;10(1):16970.
20. Li J, Li R, Gao Y, Jin X, Zhang J, Ren J et al. Increasing serum ammonia level is a risk factor for the prognosis of critically ill patients: A multicenter retrospective cohort study. J Crit Care. 2021;62:218-22.
21. Shawcross DL, Sharifi Y, Canavan JB, Yeoman AD, Abeles RD, Taylor NJ et al. Infection and systemic infammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis. J Hepatol. 2011;54(4):640-9.