The Role of 8% Branched Amino Acids (BCAA) in Patients with Hepatic Encephalopathy: 8% Branched Amino Acids in Patients with Hepatic Encephalopathy

Arslan Shahzad; Muhammad Abdul Quddus; Amna Manzoor; Ruksana Munawar; Rizwan Saeed; Hamayun Mumtaz

doi:10.54393/pjhs.v6i3.2782

Authors

Arslan Shahzad Department of Gastroenterology, Fazaia Medical College, PAF Hospital, Islamabad, Islamabad, Pakistan
Muhammad Abdul Quddus Department of Gastroenterology, Poonch Medical College, Rawalkot, Pakistan
Amna Manzoor Department of Oculoplasty, Al Shifa Eye Trust Hospital, Islamabad, Pakistan
Ruksana Munawar Department of Pharmacology, Fazaia Medical College, Islamabad, Pakistan
Rizwan Saeed Department of Gastroenterology, Poonch Medical College, Rawalkot, Pakistan
Hamayun Mumtaz Department of Pathology, Poonch Medical College, Rawalkot, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i3.2782

Keywords:

Branched-Chain Amino Acids, Lactulose, Rifaximin, Mortality

Abstract

Hepatic Encephalopathy (HE) is a neuropsychiatric disorder caused by liver dysfunction, commonly seen in cirrhosis or acute liver failure. Objective: To address the safety and efficacy of branched-chain amino acids (BCAA) solution in patients with HE. Methods: This retrospective study was performed at the Sheikh Khalifa Bin Zayed Al Nahyan Hospital, CMH Rawalakot, Azad Kashmir, Pakistan. Data from patients fulfilling the eligibility criteria during the study span from February 2022 to August 2024 were analyzed. The inclusion criteria were adults aged 18-70 years, diagnosed cases of cirrhosis of the liver, and admitted with HE. The BCCA group was given 8% BCCA solution administered through intravenous (IV) transfusion. Patients receiving any other treatments were categorized as conventional treatment. Psychometric hepatic encephalopathy score (PHES), serum ammonia levels, duration of hospitalization, treatment-related adverse events, and mortality were documented. Results: 467 patients were analyzed, the median age was 54.00 (48.00-63.00) years, and 280 (60.0%) were male. 315 (67.5%) received IV BCAA, while the remaining 152 (32.5%) received conventional therapy. Patients in the BCAA group showed a significant improvement in PHES scores, (-2.1 ± 1.9 vs. -4.6 ± 2.2, p=<0.001), reduction in serum ammonia levels (45.3 ± 8.1 vs. 56.2 ± 10.8 µmol/L, p<0.001), mean duration of hospitalization (8.9 ± 3.7 vs. 10.1 ± 4.5 days, p=0.002), and mortality (3.8% vs. 9.2%, p<0.001). In the BCAA group, 8 (2.2%) patients experienced mild gastrointestinal discomfort, and 4 (1.3%) patients reported transient dizziness.Conclusions: Intravenous 8% BCAA solution effectively enhances cognitive function, lowers serum ammonia, shortens hospitalization, and reduces mortality in hepatic encephalopathy patients.

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