Relationship between the initial serum ammonia level and prognosis in critically ill patients with non-hepatic disease:a retrospective cohort study based on eICU Collaborative Research Database
Objective To investigate the relationship between the initial serum ammonia level and the risk of ICU and hospital mortalities in critically ill patients without hepatic disease.Methods A retrospective cohort study was conducted among patients admitted to the eICU Collaborative Research Database(eICU-CRD)for a single admission who had serum ammonia test records within 48 hours of the first ICU admission and had no hepatic disease.The age,sex,ethnicity,Acute Physiologic and Chronic Health Evaluation Ⅳ score(APACHE Ⅳ score),treatment methods,complications,and outcomes were extracted.Univariable and multivariable Logistic regression were used to analyze the relationship between serum ammonia level and the risk of mortality.Interactions were used to analyze whether the relationship between serum ammonia level and the risk of mortality differed in subgroups of APACHE Ⅳ scores,age,sex,and ethnicity;subgroup analyses were made.Results A total of 1 674 patients were included.The multivariable Logistic regression showed that for every 10 μg/dL increase in ammonia,the risk of ICU death increased by 6.9％(OR=1.069,95％CI:1.036-1.104),and the risk of hospital death increased by 4.6％(OR=1.046,95％CI:1.017-1.076).The risk of ICU death was 1.7 times greater in patients with initial ammonia level of 49-82 μg/dL than in those with＜49 μg/dL(OR=1.700,95％CI:1.165-2.482),the risk of ICU death was 2.862 times greater in patients with a level of ≥82 μg/dL compared to those with＜49 μg/dL(OR=2.862,95％CI:1.792-4.570),and the risk of hospital death was 1.844 times higher in the ≥82 μg/dL group than in the＜49 μg/dL group(OR=1.844,95％CI:1.213-2.804).There were no significant differences between initial ammonia level and the risk of mortalities in different subgroups of APACHE Ⅳ scores,age,sex,or ethnicity.Conclusion In critically ill patients without hepatic disease,elevated initial serum ammonia level after ICU admission is associated with a high risk of ICU and hospital mortality.
intensive care unit(ICU)serum ammoniaeICU Collaborative Research Database(eICU-CRD)mortalityhepatic disease
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