Correlation Between Serum Ammonia Levels and Hepatic Encephalopathy Grade: A Retrospective Study and Comprehensive Literature Review

Background:Hepatic encephalopathy (HE) represents a major complication of liver disease, with ammonia playing a central role in its pathophysiology. However, the clinical utility of serum ammonia measurements in diagnosis and management remains controversial. Objective: To evaluate the correlation between serum ammonia levels and hepatic encephalopathy grade in patients with liver disease of various etiologies, and to compare findings with international literature. Methods: A retrospective study was conducted from April 2023 to October 2023 at Ibn Sina Hospital Emergency Department, Rabat, Morocco. Patients admitted with altered consciousness requiring intensive care management were included. Hepatic encephalopathy was graded according to West Haven Criteria. Serum ammonia levels were measured using venous sampling. Results: Twenty-eight patients were included (19 males, 9 females; mean age 53 years). All patients had elevated ammonia levels above normal range. Grade distribution: Grade 1 (2 patients), Grade 2 (14 patients), Grade 3 (12 patients), Grade 4 (0 patients). No significant correlation was found between ammonia levels and encephalopathy severity, contrasting with some historical studies but aligning with recent international guidelines. Conclusion: While ammonia elevation is consistently present in hepatic encephalopathy, its levels do not reliably correlate with clinical severity. These findings support current international guidelines recommending clinical diagnosis over laboratory-based assessment.