Table 1 Characteristics of the included studies
Author, year | No. of sites | No. of patients (BCAA vs Control) | Mean Age (years) | Definition of HE | Male n, (%) | Precipitating factor, n (%) | Initial Mean Serum Ammonia | Intervention BCAA Type and dose | Methods of BCAA administration | Comparison/Control | Outcomes | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Infection | GI Bleeding | Alcohol Abuse | |||||||||||
Rossi-Fanelli et al. 1982 [14] | 4 | 34 (17vs17) | 58.9 | Grade 3–4 (Adams and Foley classification) | 21 (61.8) | 12 (35.3) | 7 (20.6) | 1 (2.9) | 172.4 (g/dL) | BS 692a + 20% dextrose | 60 ml/L for the first 24 h (1500 ml/day), and thereafter at 80 ml/hr (2500 ml/day) until 48 h after mental recovery | Lactulose via a nasogastric tube (30–40 g every 4 h) or via the rectal route (200–300 g/day). Dextrose in isocaloric amounts and the same rate of as in intervention group | Improvement in HE (Grade 0) during 48 h |
Wahren et et al. 1983 [15] | 5 | 50 (25vs25) | 56 | Grade II–IV (Denis classification) | 28 (56.0) | 12 (24.0) | 20 (40.0) | 2 (4.0) | 2.4 times local laboratory’s upper normal limit | BCAA 20 g/L (70% leucine, 20% valine, and 10% isoleucine) in 5% glucose | 2L of BCAAs (40 g)/ day. Infusions were given for 20 h/ day, and therapy was continued for 1 day after HE improved to Grade 0 or I, or for a maximum of 5 days | Glucose (5%) alone, 2 L/day | Improvement in HE (Grade 0–II) during 5 days 30-day mortality |
Vilstrup 1990 [16] | 3 | 65 (32vs33) | 55.5 | Grade II–IV (Fogarty classification) | 47 (72.3) | 15 (23.1) | 20 (31.0) | 3 (4.6) | N/A | 1 g/kg/day of amino acid with 40% branched chain contents | Central venous infusion | Isocaloric 8% glucose | Improvement in HE (Grade 0–I) during 16 days 16-day mortality |
Mehtani et al. 2023 [17] | 1 | 70 (35vs35) | 47 | EASL-CLIF-defined ACLF with HESA grades > 2 | 62 (88.6) | 19 (27.1) | 14 (20.0) | 28 (40.0) | 134 (μmol/L) | BCAA 500 mL/day for 3 days + Lactulose 30–60 mL three times a day | Intravenous infusion | Lactulose alone 30–60 mL three times a day | Improvement in HE at day 28b 28-day mortality |