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Abstract Details
Variability and Lability of Ammonia Levels in Healthy Volunteers and Patients With Cirrhosis: Implications for Trial Design and Clinical Practice
Bajaj JS1, Bloom PP2, Chung RT2, Hassanein TI3, Padilla-Martinez M3, Kayali Z4, Rockey DC5, Sasso R5, Muthukumar AR6, Lee WM6, Denney WS7, Gavis EA1, Anderson C8, Blankstein L8, Brennan AM8, Puurunen MK8, Lawitz E9. Am J Gastroenterol. 2019 Aug 21. doi: 10.14309/ajg.0000000000000384. [Epub ahead of print]
Abstract
BACKGROUND:
Ammonia levels are used to assess hepatic encephalopathy, but their levels are highly variable in clinical practice.
METHODS:
We studied factors associated with variation in ammonia values in cirrhotic patients without previous hepatic encephalopathy and healthy volunteers (HVs).
RESULTS:
Ammonia increased by 12% and 18% at 1 and 2 hour, respectively, after a protein meal in 64 cirrhotic patients (P < 0.001). In 237 HVs, ammonia levels varied significantly between sites (P < 0.0001). New site-specific ammonia upper limits based on HV levels using a strict analysis protocol differed from routinely used values. Correlation between paired fresh samples was high (r = 0.83) but modest between fresh and frozen samples (r = 0.62).
CONCLUSIONS:
Sample handling, processing, and protein intake impact ammonia levels across sites.
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