Measurement of arterial
ammonia has been used as a diagnostic test for
hepatic encephalopathy, but obtaining an arterial specimen is an invasive procedure. The aim of this study was to evaluate the ability of a minimally invasive, highly sensitive optical sensing device to detect
ammonia in the breath of patients with
end-stage liver disease and to evaluate the correlation of breath
ammonia levels, arterial
ammonia levels, and psychometric testing. Fifteen subjects with
liver cirrhosis and clinical evidence of
hepatic encephalopathy underwent mini-mental status examination, number connection test, focused neurological examination, and arterial
ammonia testing. On the same day, breath
ammonia testing was performed using an apparatus that consists of a sensor (a thin membrane embedded with a pH-sensitive
dye) attached to a fiberoptic apparatus that detects optical absorption. Helicobacter pylori testing was performed using the 14C
urea breath test. A positive correlation was found between arterial
ammonia level and time to complete the number connection test (r = 0.31, P = 0.03). However, a negative correlation was found between breath
ammonia level and number connection testing (r = -0.55, P = 0.03). Furthermore, no correlation was found between breath and arterial
ammonia levels (r = -0.005, P = 0.98). There is a significant correlation between the trailmaking test and arterial
ammonia levels in patients with
cirrhosis. However, no correlation was found between breath and arterial
ammonia levels using the fiberoptic
ammonia sensor apparatus in this small study.