1 Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.
2 Liver Center and GI Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
3 Southern California Research Center, Coronado, California, USA.
4 Inland Empire Liver Foundation, Rialto, California, USA.
5 Medical University of South Carolina, Charleston, South Carolina, USA.
6 University of Texas Southwestern Medical Center, Dallas, Texas, USA.
7 Human Predictions LLC, Cambridge, Massachusetts, USA.
8 Synlogic Inc., Cambridge, Massachusetts, USA.
9 Texas Liver Institute, University of Texas Health San Antonio, San Antonio, Texas, USA.
Ammonia levels are used to assess hepatic encephalopathy, but their levels are highly variable in clinical practice.
We studied factors associated with variation in ammonia values in cirrhotic patients without previous hepatic encephalopathy and healthy volunteers (HVs).
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).
Sample handling, processing, and protein intake impact ammonia levels across sites.