EASL;Session Title: Category 02b: Cirrhosis and its complications: Clinical aspects


Presentation Date: 31 MAR, 2011


BREATH AMMONIA TESTING OF HEALTHY SUBJECTS AND PATIENTS WITH CIRRHOSIS


R. Adrover1*, D. Cocozzella1, E. Ridruejo2, A. Garcia3, J. Romé3, A. Adrover4, M. Zicavo4, J.J. Podestá5

1Centro de Hepatología, La Plata, 2Sección Hepatología - Departamento de Medicina, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno “CEMIC”, Ciudad Autónoma de Buenos Aires, Buenos Aires, 3Hospital San Roque, Gonnet, 4Facultad de Ciencias Médicas UNLP, 5Asociación Argentina de Hidrógeno, La Plata, Argentina. *raul.adrover@gmail.com


Background and aim:
Hepatic encephalopathy is a serious neuropsychiatric complication of both acute and chronic liver disease. Symptoms can include confusion, disorientation, poor coordination and coma. The aim of this study was establish the utility of a noninvasive method to determine breath ammonia levels in cirrhotic patients with and without hepatic encephalopathy (HE) and in healthy subjects.

Materials and methods: 106 subjects, 44 women and 62 men were included; 51 were healthy subjects and 55 were cirrhotic patients. HE was defined according to the West Haven criteria. The breath ammonia concentration was measured with an electrochemical sensor and expressed in parts-per-billion.

Results:
in the healthy subjects, the breath ammonia had a mean value of 151.4 ppb (SD 7.1; 95%CI 149.4-153.4) and in cirrhotic patients 169.9 ppb (SD 23.3; 95%CI 163.5-176.2) (p < 0.0001).

Thirty seven cirrhotic patients without clinical encephalopathy had a mean exhaled ammonia level of 162.9 ppb, and 18 patients with clinical encephalopathy, had a mean value of 184.1 ppb (p 0.0011). Values of breath ammonia ≥165 ppb (AUROC 0.86, 95%CI 0.79-0.93) allow differentiating cirrhotic patients from healthy subjects; and values ≥175 ppb (AUROC 0.83, 95% CI 0.73-0.94) allows differentiating patients with from those without hepatic encephalopathy (Table).

[Ammonia values predicting clinical events]


In conclusion, this portable sensor appropriately distinguished breath ammonia among healthy subjects and cirrhotic patients with and without encephalopathy. This device may have an important role on self testing and cirrhotic patient´s care.

http://www1.easl.eu/easl2011/program/Posters/Abstract20.htm