Evaluation of the Efficacy of Branched Chain Amino Acids in the Management of Hepatic Encephalopathy Secondary to Liver Cirrhosis.

Abstract

Background: Hepatic encephalopathy is a common neuropsychiatric complication of cirrhosis, associated with significant morbidity and mortality. Its management remains challenging despite available therapies. Branched chain amino acids (BCAAs) have been proposed as an adjunct treatment, but their clinical efficacy remains controversial. This study evaluated BCAAs in patients with cirrhosis-related hepatic encephalopathy.

Objective: To assess the efficacy of branched chain amino acids in improving consciousness levels in patients with hepatic encephalopathy secondary to liver cirrhosis, using the West-Haven classification for clinical grading.

Study design: A Descriptive Case Series.

Place and duration of study: Department of Gastroenterology Ward Ayub teaching hospital abbottabad from jan 2023 to jan 2024

Methods: This descriptive case series was conducted in the Department of Gastroenterology, Ayub Teaching Hospital, Abbottabad from jan 2023 to jan 2024. Patients ≥40 years, of either gender, with hepatic encephalopathy due to cirrhosis were included. Diagnosis and severity were assessed using the West-Haven classification. Intravenous branched chain amino acids were administered. Clinical response was recorded on the third day post-admission and stratified according to baseline demographics and disease severity.

Results: A total of 196 patients were enrolled, comprising 109 males (55.6%) and 87 females (44.4%). The mean age was 53.8 ± 10.2 years. Hepatotoxicity developed in 96 (49%) patients during treatment. Clinical efficacy of BCAAs showed no significant difference across age, gender, or baseline West-Haven grade. Statistical analysis revealed a p-value >0.05, indicating no significant therapeutic benefit. Although minor symptomatic improvements were observed in some individuals, BCAAs did not provide consistent clinical outcomes. These findings suggest that branched chain amino acids may not play a definitive role in the management of hepatic encephalopathy due to liver cirrhosis.

Conclusion: This study concludes that intravenous branched chain amino acids do not  significantly improve clinical outcomes in patients with hepatic encephalopathy secondary to cirrhosis of the liver. Their efficacy was not influenced by age, gender, or baseline severity of encephalopathy. Given the lack of statistical benefit, routine use of BCAAs for hepatic encephalopathy cannot be recommended. Larger, controlled trials are warranted to further clarify their role in management protocols.