Title: Parenteral nutrition with branched-chain amino acids in hepatic encephalopathy: Meta analysis
Abstract: HepatologyVolume 11, Issue 6 p. 1083-1084 Hepatology ElsewhereFree Access Parenteral nutrition with branched-chain amino acids in hepatic encephalopathy: Meta analysis Rebecca Dersimonian S.M., S.D., Rebecca Dersimonian S.M., S.D. Department of Public Health Yale University School of Medicine New Haven, Connecticut 06510Search for more papers by this author Rebecca Dersimonian S.M., S.D., Rebecca Dersimonian S.M., S.D. Department of Public Health Yale University School of Medicine New Haven, Connecticut 06510Search for more papers by this author First published: June 1990 https://doi.org/10.1002/hep.1840110627Citations: 18AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract The authors undertook a meta analysis of nine randomized clinical trials (RCTs) in which modified amino acid solutions that contained supplemental amounts of branched-chain amino acida (BCAA) were compared with other forms of therapy of hepatic encephalopathy (HE). When five RCTs were pooled, analysis showed highly significant improvement in the degree of HE (p < 0.001). Various interpretations of the data gave similar reslts. The mortality data differed so widely in these RCTs that pooling of the data could not be meaningfully performed. In two RCTs BCAA therapy resulted in increased mortality, whereas in two others BCAA treatment was associated with increased survival. An aggregate relative risk reduction of 0.59 was calcilated with 95% confidence intervals of 0.23 to 0.80 (p < 0.002). When the data from one additional study that had not yet been published and that showed BCAA therapy to be beneficial was added to the analysis, the pooled relative reduction was even greater i. e., 0.82 [p < 0.0001]. The mortality in these studies was significantly reduced regardless of the type of statistical analysis performed (p = 0.023), Nevertheless, because of the short duration of follow-up in these studies and the striking differences in the effects of BCAA on mortality, the authors recommended that additional RCTs with prolonged follow-up be performed. References 1 Rossi-Fanelli F, Riggio O, Cangiano C. Branched chain amino acids versus lactulose in the treatment of hepatic coma: a controlled study. Dig Dis Sci 1982; 27: 929–935. 10.1007/BF01316578 CASPubMedWeb of Science®Google Scholar 2 Wahren J, Denis J, Dursurmont P, Eriksson LS, Escoffier J-M, Gauthier AP, Hagenfeldt L, et al. Is intravenous administration of branched chain amino acids effective in the treatment of hepatic encephalopathy?. A multicenter study. HEPATOLOGY 1983; 3: 475–480. 10.1002/hep.1840030402 PubMedWeb of Science®Google Scholar 3 Michel H. Pomier-Layrargues G, Aubin JP, Bories P, Mirouze D, Bellet-Hermann H. Treatment of hepatic encephalopathy by infusion of a modified amino-acid solution: results of a controlied study in 47 cirrhotic patients. In In: L Capocaccia, JE Fischer, F Rossi-Fanelli, eds. Hepatic encephalopathy in chronic liver failure. New York: Plenum, 1984; 323–333. Google Scholar 4 Cerra FB, Cheung NK, Fischer JE, Kaplowitz N, Schiff ER, Dienstag JL, Bower RH, et al. Disease-specific amino acid infusion (FO80) in hepatic encephalopathy: a prospective, randomized, double-blind, controlled trial. J Parenter Enteral Nutr 1985; 9: 288–295. 10.1177/0148607185009003288 CASPubMedWeb of Science®Google Scholar 5 Eriksson LS, Conn HO. Branched-chain amino acids in the management of hepatic encephalopathy: an analysis of variants. HEPATOLOGY 1989; 10: 228–246. 10.1002/hep.1840100218 PubMedWeb of Science®Google Scholar 6 Michel H, Bories P, Aubin JP, Pomier-Layrargues G, Bauret P, Bellet-Herman H. Treatment of acute hepatic encephalopathy in cirrhotics with a branched-chain amino acids enriched versus a conventional amino acids mixture. Liver 1985; 5: 282–289. 10.1111/j.1600-0676.1985.tb00250.x PubMedWeb of Science®Google Scholar 7 DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clinical Trials 1986; 7: 177–188. 10.1016/0197-2456(86)90046-2 CASPubMedGoogle Scholar Citing Literature Volume11, Issue6June 1990Pages 1083-1084 ReferencesRelatedInformation