Effect of parenteral amino acid supplementation on short-term and long-term outcomes in severe alcoholic hepatitis: a randomized controlled trial.
The effect of parenteral amino acid administration on nutritional state, liver function and mortality was assessed in patients with severe alcoholic hepatitis. Twenty-eight patients received 2 l/day of a solution of dextrose (65 gm/L) and amino acids (25.8 gm/L) for 1 mo, whereas 26 received only the dextrose solution. All patients were allowed to eat a standard hospital diet. During the month in the hospital, there were six deaths in the treatment group and five deaths in the control group. Nitrogen balance improved in the treated group, but not in the control group. Creatinine-height index, triceps skin fold measurement and levels of serum albumin and prealbumin increased similarly in both groups. Serum retinol binding protein increased more in the treatment group than it did in the control group, and transferrin was increased only in the treatment group. Serum bilirubin, type III amino-terminal procollagen peptide and aminopyrine clearance improved more in the treatment group than in the control group, whereas serum AST and prothrombin time improved in the treatment group but not in the control group. Cumulative 2-yr survival rates from the day of entry into the study were 42% and 38% in the treatment and control groups, respectively. Patients who survived 2 yr and patients in the treatment group who died during the 2-yr follow-up had continued improvement in serum retinol binding protein, transferrin, bilirubin and prothrombin time. These parameters were unchanged in patients in the control group who died during follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
Mezey
E
E
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205.
Caballería
J
J
Mitchell
M C
MC
Parés
A
A
Herlong
H F
HF
Rodés
J
J
D000328:Adult; D000428:Alcohol Drinking; D000596:Amino Acids / Q000008:administration & dosage* / Q000627:therapeutic use; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006519:Hepatitis, Alcoholic / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D016019:Survival Analysis; D013997:Time Factors
D000596:Amino Acids