Pediatrik ve Eriþkin Karaciðer Yoðun Bakým Ünitesinde Hiperammonemi ve Hepatik Ensefalopati

Amaç
Hepatik Ensefalopatinin (HE) nörotoksisitesine neden olan kesin mekanizma hala bilinmemektedir. Bu retrospektif çalýþmada hiperamonyemi sýklýðýný ve hepatik ensefalopati ile iliþkisini tanýmlamayý amaçladýk.
Material ve Method
Organ Nakli ve Hepato-Pankreato-Bilier Cerrahisi Yoðun Bakým Ünitesi'nde Aðustos 2021-Aðustos 2022 tarihleri arasýnda takip edilen 190 hastanýn kayýtlarý geriye dönük olarak incelendi. Yoðun Bakým Ünite’sindeki kaldýklarý süre boyunca amonyak düzeyi ölçülen 111 yetiþkin ve çocuk hasta çalýþmaya dahil edildi.West Haven Criteria ile deðerlendirildi. Gruplarda 0-4 arasý HE grades mevcuttu.
Bulgular
111 hastanýn yaþ medyan (aralýk) 5 (0-16) çocuk ve 60 (20-104) yetiþkin idi. Amonyak deðeri medyan(aralýk) 42,2 (16-314) idi. Tüm hastalarýn 39'unda (%35) hiperamonyemi mevcuttu. Hiperamonyemi ve evre 0 ensefalopatisi olan hastalar 16(%14), evre 1-2 hastalar 11(%10), evre 3 hastalar 12(%11) idi.
Tartýþma ve Sonuç
Bulgularýmýz ve literatür kanýtlarýmýz, HE geliþiminden sorumlu birincil faktörün amonyaðýn olduðu görüþünü güçlü bir þekilde desteklerken, amonyak dýþýndaki faktörlerin sadece HE'yi alevlendirebileceðini göstermektedir. Ek olarak ALF'li ve ACLF'li hastalarda artan amonyak deðerinin ensefalopati derecesindeki artýþla korele olduðunu düþünmekteyiz. (SETB-2022-09-215)

Hyperammonemia and Hepatic Encephalopathy in Pediatric and Adult Liver Intensive Care Unit

Objectives: The exact mechanism that causes the neurotoxicity of hepatic encephalopathy (HE) is still unknown. In this retrospective study, we aimed to define the frequency of hyperammonemia and its relationship with HE.
Methods: The records of 190 patients who were followed up in the Organ transplantation and Hepato-pancreato-biliary surgery intensive care unit (ICU) between August 2021 and August 2022 were reviewed retrospectively. 111 adults and children whose ammonia levels were examined during their stay in the ICU were included in the study He was evaluated with West Haven Criteria. HE had grades 0–4 in the groups.
Results: The median age (range) was 5 (0–16) children and 60 (20–104) adults. The median ammonia value (range) was 42,2 (16–314). Hyperammonemia was present in 39 patients (35%) of all patients. Patients with hyperammonemia and grade 0 encephalopathy were 16 (14%), grade 1–2 patients were 11(10%), and grade 3 patients were 12 (11%).
Conclusion: While our findings and literature evidence strongly support the view that ammonia is the primary factor responsible for, HE development, it shows that factors other than ammonia can only exacerbate HE. In addition, we think that the increased ammonia value in patients with acute liver failure and acute on chronic liver failure is correlated with the increase in the degree of encephalopathy.