Intravenous BCAA Infusion Does Not Lead to a Sustained Recovery From Overt HE in ACLF - An Open Label Randomized
Rohit Mehtani1, Madhumita Premkumar1, Shankey Garg2
1Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Journal of Clinical and Experimental Hepatology
|November 17, 2023
Summary
Intravenous branched-chain amino acids (IV-BCAA) with lactulose showed a rapid but not sustained improvement in hepatic encephalopathy (HE) in acute-on-chronic liver failure (ACLF) patients. This treatment did not improve overall survival at 28 days.
Area of Science:
- Hepatology
- Gastroenterology
- Clinical Nutrition
Background:
- Hepatic encephalopathy (HE) significantly increases morbidity and mortality in acute-on-chronic liver failure (ACLF).
- Effective treatments for HE in ACLF are crucial for improving patient outcomes.
- Understanding the role of specific nutritional interventions like IV-BCAA is important.
Purpose of the Study:
- To evaluate the efficacy of intravenous branched-chain amino acids (IV-BCAA) combined with lactulose versus lactulose alone for improving HE in ACLF patients.
- To assess the impact of IV-BCAA on HE grade at 24 hours, day 3, and day 7.
- To determine the effect on overall survival and intensive care unit (ICU) stay.
Main Methods:
- A prospective, randomized controlled trial was conducted involving European association for study of liver (EASL) defined ACLF patients with overt HE.
- Patients were randomized into two groups: IV-BCAA (500 mL/day for 3 days) plus lactulose, or lactulose alone.
- The primary outcome was an improvement of at least one grade in HE, assessed using the hepatic encephalopathy scoring algorithm (HESA), at 72 hours.
Main Results:
- Of 70 analyzed patients, baseline characteristics were similar between the IV-BCAA and control groups.
- A significant improvement in HESA by ≥1 grade at 24 hours was observed in the IV-BCAA arm (40%) compared to the control group (17.1%) (P=0.03).
- This improvement in HE was not sustained at days 3 or 7, and no significant difference in overall 28-day survival was found (48.5% vs 31.4%; P=0.14).
Conclusions:
- Intravenous BCAA treatment does not lead to a sustained improvement in HE grade in ACLF patients.
- While IV-BCAA may offer short-term benefits in HE management, it does not impact long-term survival.
- Further research is needed to explore sustained therapeutic strategies for HE in ACLF.
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