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Open AccessArticle

Ammonia vs. Lactic Acid in Predicting Positivity of Microbial Culture in Sepsis: The ALPS Pilot Study

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Internal Medicine Department, Marshall University, Huntington, WV 25755, USA
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Nephrology Department, Marshall University, Huntington, WV 25755, USA
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Pulmonary & Critical Care Department, Marshall University, Huntington, WV 25701, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(8), 182; https://doi.org/10.3390/jcm7080182
Received: 12 June 2018 / Revised: 23 July 2018 / Accepted: 24 July 2018 / Published: 26 July 2018
(This article belongs to the Section Hematology)
Objective: The use of serum ammonia as a novel marker for sepsis compared to lactic acid levels in intensive care unit (ICU) patients. Design and Interventions: Single arm, prospective clinical trial to collect arterial blood samples from patients with sepsis. Serial ammonia and lactic acid levels were sent every six hours for a total of three days. Measurements and results: Compare mean levels of ammonia and lactic acid in terms of diagnosing sepsis and patient outcome, including length of stay and mortality. A total of 30 patients were enrolled in the pilot study. On admission, mean ammonia level was 35.7 μmol/L and lactic acid was 3.06 mmole/L. Ammonia levels checked at the end of day 2 (ammonia 2-4) and the beginning of day 3 (ammonia 3-1) were higher in patients who had a microbial culture-proven sepsis (p-values 0.029 and 0.002, respectively) compared to those without culture-positive sepsis. Ammonia levels did predict a longer hospital stay; ammonia level of more than 40 μmol/L had a mean hospital stay of 17.6 days vs. patients with normal levels who had a mean hospital stay of 9.62 days (p-value 0.0082). Conclusion: Elevated ammonia level can be a novel biomarker for sepsis, comparable to conventional markers. Ammonia levels have a prognostic utility as elevated levels were associated with longer hospital stay. View Full-Text
Keywords: ammonia; sepsis; microbial cultures; SIRS; bacterial infections; lactic acid ammonia; sepsis; microbial cultures; SIRS; bacterial infections; lactic acid
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Numan, Y.; Jawaid, Y.; Hirzallah, H.; Kusmic, D.; Megri, M.; Aqtash, O.; Amro, A.; Mezughi, H.; Maher, E.; Raru, Y.; Numan, J.; Akpanudo, S.; Khitan, Z.; Shweihat, Y. Ammonia vs. Lactic Acid in Predicting Positivity of Microbial Culture in Sepsis: The ALPS Pilot Study. J. Clin. Med. 2018, 7, 182.

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