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Hyperammonemia a Marker for Sepsis: A Single Arm Clinical Trial
Description
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A1819 - Hyperammonemia a Marker for Sepsis: A Single Arm Clinical Trial
Author Block: Y. Jawaid1, Y. R. Shweihat2, H. Hirzallah1, K. Damir1, O. Aqtash1, M. A. Megri3, H. Mezughi1, A. Amro1, M. Emmon1, R. Yonus1, A. Najim1, G. Todd1, H. Visweshwar1, H. Awadeh1, R. Carroll1, M. Kanaan1, Y. Numan1; 1Internal Medicine, Marshall University School of Medicine, Huntington, WV, United States, 2Internal Medicine, Marshall University, Huntington, WV, United States, 3Internal Medicine, Marshall, Huntington, WV, United States.
Introduction
Sepsis is the one of the most common form of admission to the intensive care units and has a high mortality rate. A composite of lab and physical parameters are implemented in for the early detection and severity of sepsis. Lactic acid is used for diagnosis and severity. However lactic acid and it`s role in sepsis has come under scrutiny due to non aerobic causes of hyperlactemia secondary to lack of clearance and increased production secondary to excessive aerobic glycolysis. We aim to determine the role of serum ammonia in predicting the onset and severity sepsis and it`s correlation with mortality and length of stay.
Methods
A prospective single arm clinical study was designed in a single center at a university hospital for the medical ICU. Patient with sepsis upon admission were recruited into the study. IRB regulation were observed and informed consent waived. Serial arterial ammonia and lactic acids were sent every six hours and transported on ice for the first 72 hours. Parameters recorded included lactic acid, ammonia, blood cultures, fungal cultures, serum procalcitonin, white cell count, amount/duration of pressors, IV fluids, infection source, length of stay and mortality. One sample t-test was used compare different means and linear regression analysis models were used to assess interactions.
Results
Target population of 150 patient was studied. Thirty one patients have completed the study so far. Average age of the sample size was 58.3 years. 61.7% male and 38.7% female. All patient recruited were caucasians. Average ammonia level on admission was 34.9 and lactic acid was 3.06. Sensitivities and specificities were compared to blood cultures. Hyperammonemia was predictive of a positive blood cultures positivity on day three p value 0.04. Hyperammonemia on admission was associated with increased length of stay and higher mortality.
Conclusion
Ammonia has a comparable sensitivity and specificity to lactic acid in sepsis. It was associated with higher positivity rate of blood culture i.e the true diagnosis of sepsis.Hyperammonemia was associated with longer hospital stay but not mortality.
Author Block: Y. Jawaid1, Y. R. Shweihat2, H. Hirzallah1, K. Damir1, O. Aqtash1, M. A. Megri3, H. Mezughi1, A. Amro1, M. Emmon1, R. Yonus1, A. Najim1, G. Todd1, H. Visweshwar1, H. Awadeh1, R. Carroll1, M. Kanaan1, Y. Numan1; 1Internal Medicine, Marshall University School of Medicine, Huntington, WV, United States, 2Internal Medicine, Marshall University, Huntington, WV, United States, 3Internal Medicine, Marshall, Huntington, WV, United States.
Introduction
Sepsis is the one of the most common form of admission to the intensive care units and has a high mortality rate. A composite of lab and physical parameters are implemented in for the early detection and severity of sepsis. Lactic acid is used for diagnosis and severity. However lactic acid and it`s role in sepsis has come under scrutiny due to non aerobic causes of hyperlactemia secondary to lack of clearance and increased production secondary to excessive aerobic glycolysis. We aim to determine the role of serum ammonia in predicting the onset and severity sepsis and it`s correlation with mortality and length of stay.
Methods
A prospective single arm clinical study was designed in a single center at a university hospital for the medical ICU. Patient with sepsis upon admission were recruited into the study. IRB regulation were observed and informed consent waived. Serial arterial ammonia and lactic acids were sent every six hours and transported on ice for the first 72 hours. Parameters recorded included lactic acid, ammonia, blood cultures, fungal cultures, serum procalcitonin, white cell count, amount/duration of pressors, IV fluids, infection source, length of stay and mortality. One sample t-test was used compare different means and linear regression analysis models were used to assess interactions.
Results
Target population of 150 patient was studied. Thirty one patients have completed the study so far. Average age of the sample size was 58.3 years. 61.7% male and 38.7% female. All patient recruited were caucasians. Average ammonia level on admission was 34.9 and lactic acid was 3.06. Sensitivities and specificities were compared to blood cultures. Hyperammonemia was predictive of a positive blood cultures positivity on day three p value 0.04. Hyperammonemia on admission was associated with increased length of stay and higher mortality.
Conclusion
Ammonia has a comparable sensitivity and specificity to lactic acid in sepsis. It was associated with higher positivity rate of blood culture i.e the true diagnosis of sepsis.Hyperammonemia was associated with longer hospital stay but not mortality.
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