Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
J Crit Care. 2021 Apr;62:218-222. doi: 10.1016/j.jcrc.2020.12.028. Epub 2020 Dec 31.
To assess the association between serum ammonia level upon admission during the initial intensive care unit (ICU) stay and mortality.
This retrospective cohort study included 2703 adult patients in eICU Collaborative Research Database. The ICU mortality within ammonia deciles were assessed. Logistic regression analyses were performed to analyze the relationship between ammonia and mortality.
We defined three ammonia categories: <47, 47-111, and ≥111 μg/dL, corresponding to low, intermediate, and high ICU mortality. Increased ammonia was significantly associated with increased ICU mortality (per 10 μg/dL increase: odds ratio, 1.070 [95% confidence intervals, 1.05-1.09]; intermediate vs. low: 1.90 [1.41-2.56]; high vs. low: 4.38 [2.99-6.41]) and in-hospital mortality (1.06 [1.04-1.08]; 1.45 [1.13-1.87]; 3.41 [2.43-4.79]). Adding ammonia to the Acute Physiology and Chronic Health Evaluation (APACHE) IV score improved the area under the curve from 0.826 to 0.839 (P < 0.001) and from 0.806 to 0.813 (P = 0.001) for ICU and in-hospital mortality, respectively. Interaction and subgroup analyses demonstrated consistent results in patients with different APACHE IV scores, with or without hepatic diseases.
Elevated serum ammonia level in critically ill patients upon admission was an early risk factor for higher ICU and in-hospital mortality.
评估初始重症监护病房（ICU）住院期间入院时血清氨水平与死亡率之间的关系。
本回顾性队列研究纳入了 eICU 协作研究数据库中的 2703 名成年患者。评估了氨十等分组内的 ICU 死亡率。进行 logistic 回归分析以分析氨与死亡率之间的关系。
我们定义了三个氨类别：<47、47-111 和≥111μg/dL，分别对应低、中、高 ICU 死亡率。氨升高与 ICU 死亡率增加显著相关（每增加 10μg/dL：优势比，1.070[95%置信区间，1.05-1.09]；中 vs. 低：1.90[1.41-2.56]；高 vs. 低：4.38[2.99-6.41]）和院内死亡率（1.06[1.04-1.08]；1.45[1.13-1.87]；3.41[2.43-4.79]）。将氨添加到急性生理学和慢性健康评估（APACHE）IV 评分中，分别使 ICU 和院内死亡率的曲线下面积从 0.826 提高到 0.839（P<0.001）和从 0.806 提高到 0.813（P=0.001）。交互和亚组分析表明，在具有不同 APACHE IV 评分的患者中，无论是否存在肝脏疾病，均有一致的结果。
危重症患者入院时血清氨水平升高是 ICU 和院内死亡率较高的早期危险因素。
