Research Article

Relationship between Nonhepatic Serum Ammonia Levels and Sepsis-Associated Encephalopathy: A Retrospective Cohort Study

Table 1

Baseline characteristics and outcome.

Baseline variablesOriginal cohortPropensity score matching
SAE patients n = 465Non-SAE patients n = 255SAE patients n = 232Non-SAE patients n = 232

Age64 (55–72)68 (58–75)0.00266 (60–74)68 (58–75)0.843
Sex (female) (n (%))193 (41.5)97 (38)0.364127 (54.7)146 (62.9)0.09
Coexisting illness (n (%))
 Charlson’s comorbidity index5 (3–8)6 (4–8)0.1136 (4–8)6 (4–8)0.747
 Hypertension57 (12.3)70 (27.5)<0.00141 (17.7)53 (22.8)0.204
 Diabetes134 (28.8)73 (28.6)0.95777 (33.2)64 (27.6)0.226
 Respiration91 (19.6)37 (14.5)0.08953 (22.8)34 (14.7)0.032
 Cardiovascular130 (28.0)72 (28)0.93773 (31.5)68 (29.3)0.686
 Renal96 (20.6)71 (27.8)0.02952 (22.4)63 (27.2)0.282
Site of infection (n (%))
 Intestinal14 (3.0)11 (4.3)0.3619 (3.9)5 (2.2)0.416
 Urinary24 (5.2)31 (12.2)<0.00119 (8.2)20 (8.6)1.000
 Lung19 (4.1)27 (10.6)0.00115 (6.5)15 (6.5)1.000
 Catheter7 (1.5)12 (4.7)0.0106 (2.6)7 (3.0)1.000
 Skin and soft tissue25 (5.4)20 (7.8)0.19116 (6.9)13 (5.6)0.701
 Abdominal cavity15 (3.2)18 (7.1)0.01912 (5.2)11 (4.7)1.000
Microbiology type (n (%))
Klebsiella51 (11.0)49 (19.2)0.00234 (14.7)37 (15.9)0.796
Acinetobacter baumannii4 (0.9)1 (0.4)0.4692 (0.9)1 (0.4)1.000
Escherichia coli88 (18.9)74 (29.0)0.00261 (26.3)60 (25.9)1.000
Pseudomonas aeruginosa32 (6.9)34 (13.3)0.00425 (10.8)27 (11.6)0.883
Staphylococcus aureus8 (1.7)14 (5.5)0.0058 (3.4)7 (3.0)1.000
Enterococcus180 (38.7)84 (32.9)0.12488 (37.9)72 (31.0)0.143
Vital signs, median (IQR)
 Heart rate (bmp)105 (90–117)103 (91–118)0.635104.5 (90–117)103.0 (90–118)0.83
 Systolic blood pressure (mmHg)90 (80–100)88 (77–101)0.27390 (79–100)88 (77–100)0.553
 Diastolic blood pressure (mmHg)45 (38–53.5)45 (37.5–51)0.32144 (37–52)45 (37.9–51)0.496
 Mean arterial pressure (mmHg)58 (50–66)56 (49–65)0.13157 (50–65)56 (49–64.3)0.606
 Respiratory rate (bmp)28 (24–32)28 (24–32)0.95127.5 (24–32)28 (24–32)0.932
 Temperature (°C)37.2 (36.9–37.7)37.2 (36.9–37.7)0.43137.2 (36.9–37.7)37.2 (37–37.7)0.274
 SPO2 (%)93 (90–95)93 (91–95)0.72593 (90–95)93.00 (91–95)0.889
Laboratory parameters, median (IQR)
 Alanine aminotransferase (IU/L)40 (20–44)34 (18–40)0.05735 (18.8–41.5)32.5 (18–40)0.358
 Aspartate aminotransferase (IU/L)48 (26–55.5)42 (23–51)0.11443 (24.8–54)41 (23–53)0.58
 Albumin (g/dL)3.2 (2.6–3.7)3.2 (2.7–3.8)0.1683.2 (2.7–3.7)3.2 (2.7–3.8)0.707
 Bilirubin (mg/dL)1.4 (0.5–1.9)1.3 (0.5–2.1)0.5051.3 (0.5–1.9)1.2 (0.5–2.10)0.845
 Creatinine (mg/dL)1.3 (0.8–2.1)1.3 (0.9–2.3)0.1111.4 (0.8–2.1)1.3 (0.9–2.2)0.472
 Blood urea nitrogen (mg/dL)27 (16–46)26 (18–40)0.65829.5 (18–49)26.5 (18–40)0.225
 Glucose (mg/dL)103 (87–126)107 (93–126)0.105102 (87–126)106 (93.8–126)0.207
 Hemoglobin (g/dL)9.0 (7.8–10.7)9.0 (7.9–10.6)0.9348.9 (7.8–10.5)9.0 (7.9–10.7)0.776
 Platelet (×109/L)140 (82–206)173 (98–242)0.001166 (88.5–230.5)168 (96.5–237.3)0.580
 Partial thrombin time (s)37.2 (30.3–48.0)36.5 (30.4–47.7)0.82237.4 (31–47.9)36.3 (30.5–47.7)0.287
 International normalized ratio1.6 (1.2–1.9)1.5 (1.2–1.9)0.2361.6 (1.2–1.9)1.5 (1.2–1.9)0.418
 Prothrombin time (s)15.3 (12.8–18.1)16.3 (13.4–22.9)0.29017.0 (13.6–22.4)16.0 (13.4–22.4)0.394
 White blood cell (×109/L)11.0 (7.7–15.6)11.0 (7.6–16.2)0.78211.3 (7.6–16.1)11.0 (7.9–16.2)0.829
 Neutrophils (%)71.6 (66.4–80.7)71.6 (68–80.9)0.59171.6 (65.9–81.4)71.8 (68.2–81.4)0.412
 Lymphocyte (%)17.2 (10–20.2)16.1 (10.1–20)0.62917.2 (9–21)16.1 (10–20)0.823
 Ammonia (μmol/L)41 (31–63)21 (16–31)<0.00156.5 (40–79.3)21.5 (17–32)<0.001
 Lactates (mmol/l)1.8 (1.3–2.5)1.6 (1.3–2.3)0.2021.9 (1.3–2.5)1.6 (1.3–2.3)0.167
 PaO2 (mmHg)123 (88–132.5)125 (90–133)0.525123 (87–132.8)125 (90.8–130.3)0.608
 PaCO2 (mmHg)44 (39–46)45 (41–46)0.05944 (39–46)45 (42–46)0.042
Analgesic and sedative drugs (n (%))
 Midazolam12 (2.6)9 (3.5)0.46910 (4.3)7 (3.0)0.621
 Propofol11 (2.4)15 (5.9)0.01611 (4.7)10 (4.3)1.000
 Opioids35 (7.5)8 (3.1)0.0177 (3.0)8 (3.4)1.000
 Mechanical ventilation (n (%))250 (53.8)105 (41.2)0.001125 (53.9)95 (40.9)0.007
 Renal replacement therapy (n (%))41 (8.8)27 (10.6)0.43717 (7.3)21 (9.1)0.612
Score system
 SAPS II38 (30–47)37 (29–45)0.14441 (32–49.3)37 (28–45)0.001
 SOFA6 (4–10)5 (3–8)<0.0016 (4–10)5 (3–7)<0.001
 GCS10 (7–13)15 (15–15)<0.00110 (6–13)15 (15–15)<0.001
 Use of vasopressors (n (%))182 (39.1)101 (39.6)0.90290 (38.8)93 (40.1)0.849
 Length of hospital stays, days4.6 (1.9–11.7)2.6 (1.3–6.2)<0.0014.2 (1.8–10.8)2.8 (1.3–6.0)<0.001
 Hospital mortality (n (%))96 (20.6)3 (1.2)<0.00142 (18.1)2 (0.9)<0.001

PaCO2: partial pressure of carbon dioxide; SpO2: arterial oxygen saturation; PaO2: partial pressure of oxygen; GCS: Glasgow Coma Scale; SAPS II: Simplified Acute Physiology Score; SOFA: Sequential Organ Failure Assessment.