[Value of blood ammonia on predicting the severity and prognosis of patients with sepsis: a prospective observation study].

OBJECTIVE:To investigate the value of arterial blood ammonia on predicting the severity and prognosis of patients with sepsis. METHODS:A prospective observation study was conducted. A total of 169 patients with sepsis admitted to intensive care unit (ICU) of Jining First People's Hospital Affiliated to Jining Medical University from January 2018 to June 2019 were enrolled. Thirty-five healthy volunteers were served as controls. Demographics, acute physiology and chronic health evaluation II (APACHE II) score were recorded. At 6-8 hours after the diagnosis of sepsis, the serum levels of arteria blood ammonia and whole blood cell count were run. The septic patients were divided into the sepsis group and septic shock group according to the disease severity, and the septic patients were divided into survival group and death group according to the outcomes during 28-day hospitalization. The clinical data were compared. Spearman rank correlation was applied to determine the correlation between those variables. The predictive value of the parameters on 28-day mortality was evaluated with receiver operating characteristic (ROC) curve. Kaplan-Meier survival curve analysis was used to compare different blood ammonia levels of patients with 28-day cumulative survival rate. RESULTS:Among the 169 sepsis patients, after excluding 12 patients who did not meet the inclusion criteria and loss to follow-up, there were finally 157 patients enrolled in the analysis. Among the 157 septic patients, 71 of them were in the sepsis group, and 86 in the septic shock group. After 28-day follow-up, 115 patients survived and 42 died. No significant differences were found in age and gender among groups with different severity and clinical prognosis. Compared with the control group, the blood ammonia, counts of white blood cell (WBC) and neutrophils ratio (Neut%) in serum of sepsis patients were significantly higher [blood ammonia (μmol/L): 42.28±28.64 vs. 12.05±5.44, WBC (×10 9992CONCLUSIONS:The level of arterial blood ammonia could somehow indicate the severity and prognosis of sepsis, which could provide evidence for the treatment.