Branched chain amino acids supplemented with L-acetylcarnitine versus BCAA treatment in hepatic coma: a randomized and controlled double blind study.
OBJECTIVE
Our earlier study has demonstrated that the administration of L-acetylcarnitine (LAC) improves neurological symptoms and serum parameters in hepatic coma. The aim of this work has been to evaluate the efficacy of the LAC and branched chain amino acids (BCAA) versus BCAA, administered in intravenous infusion, in patients with cirrhotic hepatic coma.


METHODS
Forty-eight highly selected patients were enrolled in the study and, after randomization, received blindly LAC+BCAA (n=24) versus BCAA (n=24). The two groups were similar in age, sex, pathogenesis of cirrhosis, and severity of liver disease. The comparison between values before and after LAC planned treatment showed statistical significant differences in neurological findings, evaluated by the Glasgow Scale, ammonia serum levels, blood urea nitrogen, and EEG.


RESULTS
After 60 min of the study period, the LAC+BCAA treated patients compared with BCCA treated showed a significant decrease of ammonia serum levels: 41.20 versus 10.40 mumol P<0.05. After 1 day of the study period, the LAC+BCAA treated patients compared with BCCA treated patients showed a significant increase of Glasgow's score: 3.60 versus 1.50 score P<0.05; a significant decrease of ammonia serum levels: 63.30 versus 27.00 mumol P<0.01; a significant improvement of EEG cps/s: 2.70 versus 0.6 P<0.001. No side-effects were observed in our study series.


CONCLUSIONS
Our study demonstrated that the administration of BCAA supplemented with LAC might improve neurological symptoms and serum ammonium levels in selected cirrhotic patients with hepatic coma.
Department of Senescence, Urological and Neurological Sciences, University of Catania, Italy. malaguar@unict.it
Mariano
M
Malaguarnera
Corrado
C
Risino
Lisa
L
Cammalleri
Lucia
L
Malaguarnera
Marinella
M
Astuto
Ignazio
I
Vecchio
Liborio
L
Rampello
D000108:Acetylcarnitine / Q000627:therapeutic use*; D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use*; D000641:Ammonia / Q000097:blood; D004311:Double-Blind Method; D004569:Electroencephalography; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014803:Vitamin B Complex / Q000627:therapeutic use*
D000597:Amino Acids, Branched-Chain; D014803:Vitamin B Complex; D000108:Acetylcarnitine; D000641:Ammonia