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Reply to: “Ammonia and prognosis of cirrhosis: A new perspective for identifying high risk patients”

  • Author Footnotes
    † Joint first authors
    Thomas H. Tranah
    Footnotes
    † Joint first authors
    Affiliations
    Institute of Liver Studies, Dept of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King´s College London, London, United Kingdom
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  • Author Footnotes
    † Joint first authors
    María-Pilar Ballester
    Footnotes
    † Joint first authors
    Affiliations
    Digestive Disease Department, Hospital Clínico Universitario de Valencia, Spain

    INCLIVA Biomedical Research Institute, Valencia, Spain
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  • Author Footnotes
    † Joint first authors
    Juan Antonio Carbonell-Asins
    Footnotes
    † Joint first authors
    Affiliations
    INCLIVA Biomedical Research Institute, Valencia, Spain
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  • Author Footnotes
    ‡ Joint senior authors
    Rajiv Jalan
    Correspondence
    Corresponding author. Address: Liver Failure Group, Institute for Liver and Disease Health, University College London, Royal Free Campus. Rowland Hill Street, London, NW3 2PF, United Kingdom; Tel.: +44 02074332795.
    Footnotes
    ‡ Joint senior authors
    Affiliations
    Liver Failure Group, Institute for Liver and Digestive Health, University College London, Royal Free Campus, United Kingdom

    European Foundation for the Study of Chronic Liver Failure (EF Clif), Spain
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  • Author Footnotes
    ‡ Joint senior authors
    Debbie L. Shawcross
    Footnotes
    ‡ Joint senior authors
    Affiliations
    Institute of Liver Studies, Dept of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King´s College London, London, United Kingdom
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  • Author Footnotes
    † Joint first authors
    ‡ Joint senior authors
Published:November 02, 2022DOI:https://doi.org/10.1016/j.jhep.2022.10.025
      We would like to thank Ridola et al. for their interest in our recently published article.
      • Tranah T.H.
      • Ballester M.P.
      • Carbonell-Asins J.A.
      • Ampuero J.
      • Alexandrino G.
      • Caracostea A.
      • et al.
      Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis.
      ,
      • Ridola L.
      • Riggio O.
      Ammonia and prognosis of cirrhosis: a new perspective for identifying high risk patients.
      Our study of 754 outpatients with cirrhosis, demonstrated that ammonia was an independent predictor of mortality and when expressed as a ratio of the local laboratory upper limit of normal (AMM-ULN), >1.4 defines a high-risk group for the development of liver-related complications. This was confirmed in an independent validation cohort of 130 stable outpatients with cirrhosis.

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      References

        • Tranah T.H.
        • Ballester M.P.
        • Carbonell-Asins J.A.
        • Ampuero J.
        • Alexandrino G.
        • Caracostea A.
        • et al.
        Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis.
        J Hepatol. 2022; (online ahead of print)
        • Ridola L.
        • Riggio O.
        Ammonia and prognosis of cirrhosis: a new perspective for identifying high risk patients.
        J Hepatol. 2022; (online ahead of print)
        • Noiret L.
        • Baigent S.
        • Jalan R.
        Arterial ammonia levels in cirrhosis are determined by systemic and hepatic hemodynamics, and by organ function: a quantitative modelling study.
        Liver Int. 2014 Jul; 34: e45-e55