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CC BY-NC-ND 4.0 · Semin Liver Dis 2024; 44(03): 356-368
DOI: 10.1055/a-2378-8942
Review Article

The Value of Ammonia as a Biomarker in Patients with Cirrhosis

Maria Pilar Ballester   *
1   Hepatology Unit, Digestive Disease Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
2   Department of Gastroenterology and Hepatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
,
Esra Nur Durmazer   *
3   Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, Turkey
,
Tingting Qi   *
4   Hepatology Unit, Department of Infectious Disease, Southern Medical University, Nanfang Hospital, Guangzhou, China
,
Rajiv Jalan
5   Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, United Kingdom
6   European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain
› Author Affiliations Financial Declarations M.P.B. has a Juan Rodes contract from Instituto de Salud Carlos III (JR23/00029).
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Abstract

Ammonia is a product of amino acid metabolism that accumulates in the blood of patients with cirrhosis and plays a pivotal role in the pathogenesis of hepatic encephalopathy (HE). Despite being one of the main drivers of brain dysfunction, for many years international societies stated that increased blood ammonia does not add any diagnostic, staging, or prognostic value for HE in patients with cirrhosis. Nonetheless, in the last decades, evidence is emerging that supports the utility of ammonia for risk stratification, but its role in guiding HE diagnosis, staging, and treatment is unclear and there is equipoise in its use in clinical practice. This review provides the latest evidence on the value of ammonia as a biomarker in patients with cirrhosis. Although correct measurement of ammonia requires disciplined sample collection, it provides extremely useful clinical guidance for the diagnosis of HE, offers prognostic information, and it defines a therapeutic target.

Keywords

ammonia - hepatic encephalopathy - cirrhosis - biomarker

* Shared first author




Publication History

Accepted Manuscript online:
02 August 2024

Article published online:
03 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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