title: Effects of branched-chain amino acid granules on serum albumin level and prognosis are dependent on treatment adherence in patients with liver cirrhosis.
abstract: OBJECTIVE
  To test if the treatment adherence to branched-chain amino acid (BCAA) granules influences the serum albumin level and prognosis in prospective 2984 patients with decompensated liver cirrhosis who were prescribed BCAA granules containing 952 mg of L-isoleucine, 1904 mg of L-leucine and 1144 mg of L-valine at 4.15 g/sachet three times a day after meals.
  
  
  METHODS
  The primary end-point was the time to the event defined as "hospital admission due to progression of hepatic failure", and factors affecting this outcome were explored. Changes in serum albumin level were evaluated as the secondary end-point.
  
  
  RESULTS
  Patients were divided into the good adherence group (those who reported to have taken "nearly all" prescribed doses) and the poor adherence group (those who reported to have taken "approximately half" or "less" doses), because such stratification was validated by treatment responses in plasma BCAA/tyrosine ratio. Factors related to the primary end-point were age, drug adherence during 6 months of study treatment, previous hepatic cancer, current clinical manifestations, previous clinical manifestations, baseline serum albumin level, platelet count and total bilirubin level. The cumulative event-free survival was significantly higher in the good adherence group. Increase in the serum albumin level was also greater in the good adherence group.
  
  
  CONCLUSIONS
  Higher BCAA treatment adherence better raised the serum albumin level, leading to improvement of event-free survival. These results indicate the importance of patient instruction for the adequate use of BCAA granules.
authors.affiliation: Department of Hepatology, Kagawa Prefectural Central Hospital, Kagawa.
authors.forename: Koichi
authors.initials: K
authors.lastname: Takaguchi
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
authors.forename: Hisashi
authors.initials: H
authors.lastname: Doyama
authors.forename: Masayuki
authors.initials: M
authors.lastname: Iida
authors.forename: Michiyasu
authors.initials: M
authors.lastname: Yagura
authors.forename: Noritomo
authors.initials: N
authors.lastname: Shimada
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kang
authors.forename: Haruki
authors.initials: H
authors.lastname: Yamada
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kumada