STUDY OF SERUM AMMONIA IN HEPATIC ENCEPHALOPATHY AND ITS CORRELATION WITH SEVERITY

Background and objectives: Hepatic encephalopathy (HE) encompasses a spectrum of manifestations ranging confusion and coma. Data on correlation of serum ammonia levels with grades of HE is inconsistent. This study was undertaken to find the correlation between serum ammonia levels and grades of HE. Methodology: This hospital based descriptive cross-sectional study was undertaken in the Department of General Medicine, from a tertiary care hospital situated in South Karnataka from November 2018 to May 2020. A total of 86 patients with HE were included in the study. Results: Majority of the patients (83.72%) were males and the male to female ratio was 5.14:1. The mean age was 54.01±11.55 years and most of the patients (36.05%) were aged from 51 to 60 years. Most of the patients had lack of awareness (47.67%) followed by disorientation (24.42%). According to West heaven criteria, most of the patients (47.67%) had grade 1 HE followed by grade 2 (24.42%), grade 3 (23.26%) and grade 4 (4.65%). The mean serum ammonia levels were 105.43±49.66 and 88.65 µg/dl. Majority of the patients (96.51%) had serum ammonia levels of >60 µg/dl. There was strong positive correlation between HE grades and serum ammonia levels (ρ=0.752 R2=0.455 p<0.001). Also, mean serum ammonia levels in grade 4 HE (203.50±107.87 µg/dl) were significantly high compared to grade 3 (139.20±41.48µg/dl), 2 (112.57±36.91µg/dl) and 1 (75.75±20.20µg/dl) (p<0.001). Conclusion and Interpretation: The serum ammonia level were elevated in patients with HE. There is strong positive correlation between HE grades and serum ammonia levels which corresponds to the severity of HE.