Association between blood ammonia and 90-day prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure

Objective To investigate the association between baseline blood ammonia (BLA) and 90-day prognosis in patients with hepatitis B virus (HBV) -related acute-on-chronic liver failure (HBV-ACLF) . Methods A retrospective analysis was performed for the clinical data of 789 patients with HBV-ACLF who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January2013 to December 2016, and the association between baseline BLA and 90-day prognosis was analyzed. The Cox regression risk model was used for multivariate analysis. The Kaplan-Meier survival curve was used to analyze the 90-day survival rate of patients with different levels of baseline BLA, and the log-rank test was used for comparison. Results The Cox multivariate regression analysis showed that BLA was independently and positively correlated with the risk of 90-day death in HBV-ACLF patients (Model 2: hazard ratio = 1. 007, 95%confidence interval: 1. 005-1. 010, P < 0. 00001) . The log-rank test indicated that in the patients without hepatic encephalopathy (HE) , the BLAhigh group had the highest 90-day cumulative mortality rate, followed by the BLAmid group and the BLAlow group (P = 0. 0023) ; among the patients with HE, the BLAhigh group had a significantly higher 90-day cumulative mortality rate than the other two groups (P= 0. 012) , while there was no significant difference in 90-day cumulative mortality rate between these two groups (P = 0. 18) . Conclusion Baseline BLA is independently and positively correlated with the risk of 90-day death in HBV-ACLF patients, and it may have a certain clinical value in treatment and prognostic evaluation.