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Background/objectives: L-Ornithine L-Aspartate (LOLA) is a mixture of two endogenous amino acids with the capacity to fix ammonia in the form of urea and/or glutamine. Its' efficacy for the treatment of Hepatic Encephalopathy (HE), a known hyperammonemic disorder, remains the subject of debate. This study quantitatively analyzed the efficacy of LOLA in patients with cirrhosis and HE. Methods: Efficacy was defined as the extent of lowering of blood ammonia and improvement of mental state assessed in clinically overt HE (OHE) by Westhaven criteria or psychometric testing for assessment of Minimal HE (MHE). Appropriate keywords were used for electronic and/or manual searches of databases to identify RCTs for inclusion. Study quality and risk of bias were assessed using the Jadad Composite Scale together with The Cochrane Scoring Tool. Random Effects Models were used to express pooled Risk Ratio (RR) or Mean Difference (MD) with associated 95% Confidence Intervals (CI). Results: 10 RCTs (884 patients) were included. Regression analysis showed no evidence of publication bias or other small study effects. Eight RCTs had low risk of bias by Jadad/Cochrane criteria. Comparison with placebo/no intervention controls revealed that LOLA was significantly more effective for improvement of mental state in all types of HE (

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The data show that pre-TIPS HE does not predict post-TIPS encephalopathy. Otherwise, CFF can reliably pick up the evolution of HE-severity after TIPS implantation. Low pre-TIPS CFF is indicative for a poor prognosis and may help to identify transplant candidates without delay.

Estimates for the reliability of Thurstone's regression factor score estimator, Bartlett's factor score estimator, and McDonald's factor score estimator were proposed. Moreover, conditions for equal reliability of the factor score estimators were presented and the reliability estimates were compared by means of simulation studies. Under conditions inducing unequal reliabilities, reliability estimates were largest for the regression score estimator and lowest for McDonald's factor score estimator. We provide an R-script and an SPSS-script for the computation of the respective reliability estimates.