Background: Because the correlation between ammonia levels and the severity of hepatic encephalopathy remains controversial, we prospectively evaluated the correlation in 121 consecutive patients with cirrhosis. Methods: The diagno‐ sis of hepatic encephalopathy was based on clinical criteria, and the severity of hepatic encephalopathy was based on the West Haven Criteria for grading of mental status. Arterial and venous blood samples were obtained from each patient. Four types of ammonia measurements were analyzed: arterial and venous total ammonia, and arterial and venous partial pressure of ammonia. Spearman rank correlations (r s) were calculated. Results: Of the 121 patients, 30 (25%) had grade 0 encephalopathy (no signs or symptoms), 27 (22%) had grade 1, 23 (19%) had grade 2, 28 (23%) had grade 3, and 13 (11%) had grade 4 (the most severe signs and symptoms). Each of the four measures of ammonia increased with the severity of hepatic encephalopathy: arterial total ammonia (r s =0.61, p ≤ .001), venous total ammonia (r s =0.56, p ≤ .001), arterial partial pressure of ammonia (r s =0.55, p ≤ .001), and venous partial pressure of ammonia (r s =0.52, p≤ .001).Conclusions: Ammonia levels correlate with the severity of hepatic encephalopathy. Venous sampling is adequate for ammo‐ nia measurement. There appears to be no additional advantage of measuring the partial pressure of ammonia compared with total ammonia levels.

This study was aimed at comparing the effectiveness of TWS vs. paracentesis in the treatment of cirrhotic patients with refractory ascites.Cirrhotic patients with refractory ascites were randomly allocated to receive TIPS or large-volume paracentesis combined with LV. albumin infusion (8 gramsl liter of tapped fluid) and then followed to be tapped when tense ascites relapsed and hospitalized when new complications developed.Patients with total portal vein thrombosis, diffuse HCC, bilirubin > 6 mgldl or Child-Pugh score> 11 were excluded.end-points of the study were efficacy of treatment, survival, renal function and quality of life.Failures of treatments were considered cases who required to be tapped more often than weekly, cases who developed renal failure (a 100% increase of creatinine over 2 mg/dl) and patients who died for SBP or hepatorenal syndrome (HRS).Until now 31 patients have been treated (19 with TIPS and 12 with paracentesis).Both groups were comparable with respect to age, sex, etiology of cirrhosis, Pugh score, renal function and mean follow up.The results in the two groups (TWS vs Paracentesis) were respectively: Age 56.5 ::' :: 7