title: Oral acetyl-L-carnitine treatment in hepatic encephalopathy: view of evidence-based medicine.
abstract: OBJECTIVE
  To systematically review the effect of acetyl-L-carnitine in patients with hepatic encephalopathy.
  
  
  METHODS
  
  
  
  METHODS
  systematic review and meta-analysis.
  
  
  METHODS
  The Cochrane Library, MEDLINE, EMBASE.com, Science Citation Index, Google search and the China Biological Medicine Database to June 2012.
  
  
  METHODS
  randomized placebo controlled trials of acetyl-L-carnitine in patients with hepatic encephalopathy assessing whether acetyl-L-carnitine is an effective therapy or not. No language restrictions were applied. Two reviewers independently extracted data and assessed quality.
  
  
  RESULTS
  7 methodologically sound randomized controlled trials were identified involving 660 participants with hepatic encephalopathy, totaling 249 with subclinical hepatic encephalopathy, 189 with West Haven grade 1, 162 with West Haven grade 2 and 60 with West Haven grade 3. Acetyl-L-carnitine was effective to improve serum ammonia level (weighted mean difference 25.90, 95% confidence intervals 20.89 to 30.91, P < 0.05) and the number connection test completion time (weighted mean difference 16.62, 95% confidence intervals 9.88 to 23.36, P < 0.05). The outcome was consistent in subgroup analyses. No publication bias was detected. Adverse events were reported infrequently and were minor.
  
  
  CONCLUSIONS
  Acetyl-L-carnitine is promising as an effective and tolerable treatment for hepatic encephalopathy that associated with improved serum ammonia levels and the number connection test.
authors.affiliation: Department of Pharmacy, the Second People's Hospital of Sichuan Province & Sichuan Provincial Cancer Hospital & Institute, Chengdu, 610041, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Jiang
authors.forename: Gang
authors.initials: G
authors.lastname: Jiang
authors.forename: Ke-qing
authors.initials: KQ
authors.lastname: Shi
authors.forename: Hong
authors.initials: H
authors.lastname: Cai
authors.forename: Yi-xin
authors.initials: YX
authors.lastname: Wang
authors.forename: Ming-hua
authors.initials: MH
authors.lastname: Zheng
mesh_terms: D000108:Acetylcarnitine / Q000008:administration & dosage* / Q000009:adverse effects; D000284:Administration, Oral; D000641:Ammonia / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003071:Cognition / Q000187:drug effects; D019317:Evidence-Based Medicine; D006501:Hepatic Encephalopathy / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D016014:Linear Models; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000108:Acetylcarnitine; D000641:Ammonia