Comparative Efficacy of Treatment Options for Minimal Hepatic Encephalopathy: A Systematic Review and Network Meta-Analysis

Dhiman, Radha K.; Thumburu, Kiran K.; Verma, Nipun; Chopra, Madhu; Rathi, Sahaj; Dutta, Usha; Singal, Ashwani K.; Taneja, Sunil; Duseja, Ajay; Singh, Meenu

doi:10.1016/j.cgh.2019.08.047

Cited by 78 publications

(64 citation statements)

References 53 publications

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“…Results were, in general, remarkably consistent with all seven meta-analyses showing evidence of improvements of mental state in patients with MHE or OHE [12][13][14][15][16][17][18][19] that was accompanied by lowering of blood ammonia in all cases. When assessed separately, either intravenous or oral formulations of LOLA were found to be effective for the treatment of HE [15][16][17][18] However, occasional inconsistencies were noted and this was attributed to differences in experimental design, inclusion/exclusion criteria or methodology used for the determination of mental state.…”

Section: Discussionsupporting

confidence: 82%

“…Results of seven systematic reviews each accompanied by metaanalysis of the results of RCTs on the efficacy of LOLA for the efficacy of treatment of MHE/OHE in patients with cirrhosis have been completed and published in the last 20 years starting with an in house analysis of five trials from Merz Pharmaceuticals (Germany) [12] Subsequent analyses by investigators from China. [13][14][15] Europe [16,17] Canada [18] and India [19] followed involving up to 36 trials and 2377 patients with cirrhosis and HE. Summaries of the numbers of RCTs, patients, year, type of HE, outcome parameters, publication reference and short synopsis of the major findings are provided in Table 2.…”

Section: Efficacy Of Lola For the Treatment Of He In Cirrhosis: Systementioning

confidence: 99%

See 1 more Smart Citation

Efficacy of L-Ornithine L-Aspartate for the prevention and Treatment of Hepatic Encephalopathy in Cirrhosis: An Update of the Evidence Base

2019

J Pharmacol Pharm Res

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Section: Discussionsupporting

confidence: 82%

Section: Efficacy Of Lola For the Treatment Of He In Cirrhosis: Systementioning

confidence: 99%

Efficacy of L-Ornithine L-Aspartate for the prevention and Treatment of Hepatic Encephalopathy in Cirrhosis: An Update of the Evidence Base

2019

J Pharmacol Pharm Res

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“…Although various drugs have been given for patients with MHE [39][40][41][42][43] to decrease ammonia levels or improve mental status, drugs that are effective against MHE are unclear. We showed that the concentration of BCAA correlated with the presence of MHE, suggesting that administration of BCAA may be a reasonable treatment for MHE, because of its potential e cacy ameliorating skeletal muscle mass loss.…”

Section: Discussionmentioning

confidence: 99%

Loss of Skeletal Muscle Mass Affects the Incidence of Minimal Hepatic Encephalopathy: A Case Control Study

Tateyama

Naoe

Tanaka³

et al. 2020

Preprint

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Background: Sarcopenia is a syndrome characterized by progressive and systemic decreases in skeletal muscle mass and muscle strength. The influence or prognosis of various liver diseases in this condition have been widely investigated, but little is known about whether sarcopenia and/or muscle mass loss are related to minimal hepatic encephalopathy.Methods: To clarify the relationship between minimal hepatic encephalopathy and sarcopenia and/or muscle mass loss in patients with liver cirrhosis. Ninety-nine patients with liver cirrhosis were enrolled. Minimal hepatic encephalopathy was diagnosed by a neuropsychiatric test. Skeletal mass index was calculated by dividing muscle area at the third lumbar vertebra by the square of height in meters.Results: MHE was detected in 48 cases (48.5%) and sarcopenia in 6 cases (6.1%). Patients were divided into two groups, with or without MHE. Comparing groups, no significant differences were seen in serum ammonia concentration or rate of sarcopenia. Skeletal muscle index was smaller in patients with minimal hepatic encephalopathy (46.4 cm2/m2) than in those without (51.2 cm2/m2, P = 0.027). Skeletal muscle index represented a predictive factor related to minimal hepatic encephalopathy (<50 cm2/m2; odds ratio 0.300, P = 0.002).Conclusions: Muscle mass loss was related to minimal hepatic encephalopathy, although sarcopenia was not. Measurement of muscle mass loss might be useful to predict MHE.

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“…Although various drugs have been given for patients with MHE [40][41][42][43][44] to decrease ammonia levels or improve mental status, drugs that are effective against MHE are unclear. We showed that the concentration of BCAA correlated with the presence of MHE, suggesting that administration of BCAA may be a reasonable treatment for MHE, because of its potential e cacy ameliorating skeletal muscle mass loss.…”

Section: Discussionmentioning

confidence: 99%

Loss of skeletal muscle mass affects the incidence of minimal hepatic encephalopathy: A case control study

Tateyama

Naoe

Tanaka³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Sarcopenia is a syndrome characterized by progressive and systemic decreases in skeletal muscle mass and muscle strength. The influence or prognosis of various liver diseases in this condition have been widely investigated, but little is known about whether sarcopenia and/or muscle mass loss are related to minimal hepatic encephalopathy (MHE).Methods: To clarify the relationship between MHE and sarcopenia and/or muscle mass loss in patients with liver cirrhosis.Methods: Ninety-nine patients with liver cirrhosis were enrolled. MHE was diagnosed by a neuropsychiatric test. Skeletal mass index (SMI) and Psoas muscle index (PMI) were calculated by dividing skeletal muscle area and psoas muscle area at the third lumbar vertebra by the square of height in meters, respectively, to evaluate muscle volume.Results: This study enrolled 99 patients (61 males, 38 females). MHE was detected in 48 cases (48.5%) and sarcopenia in 6 cases (6.1%). Patients were divided into two groups, with or without MHE. Comparing groups, no significant differences were seen in serum ammonia concentration or rate of sarcopenia. SMI was smaller in patients with MHE (46.4 cm2/m2) than in those without (51.2 cm2/m2, P = 0.027). Similarly, PMI was smaller in patients with MHE (4.24 cm2/m2) than in those without (5.53 cm2/m2, P = 0.003). Skeletal muscle volume, which is represented by SMI or PMI was a predictive factor related to MHE (SMI ≥ 50 cm2/m2; odds ratio 0.300, P = 0.002, PMI ≥ 4.3 cm2/m2; odds ratio 0.192, P = 0.001).Conclusions: Muscle mass loss was related to minimal hepatic encephalopathy, although sarcopenia was not. Measurement of muscle mass loss might be useful to predict MHE.

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Comparative Efficacy of Treatment Options for Minimal Hepatic Encephalopathy: A Systematic Review and Network Meta-Analysis

Cited by 78 publications

References 53 publications

Efficacy of L-Ornithine L-Aspartate for the prevention and Treatment of Hepatic Encephalopathy in Cirrhosis: An Update of the Evidence Base

Efficacy of L-Ornithine L-Aspartate for the prevention and Treatment of Hepatic Encephalopathy in Cirrhosis: An Update of the Evidence Base

Loss of Skeletal Muscle Mass Affects the Incidence of Minimal Hepatic Encephalopathy: A Case Control Study

Loss of skeletal muscle mass affects the incidence of minimal hepatic encephalopathy: A case control study

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