Response to L-ornitine L-aspartate in a single intravenous dose in cirrhotic patients with overt hepatic encephalopathy.

Introduction and Objectives

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that occurs in patients with acute and chronic liver disease; It is associated with a higher risk of new episodes and higher mortality at one year. L-ornithine L-aspartate (LOLA) is a stable salt that acts on two key ammonia detoxification pathways: urea synthesis and glutamine synthesis. Its intravenous administration has been studied with repeated doses and at high doses.

The objective is to describe the response to the administration of a single intravenous dose of L-ornithine L-aspartate in cirrhotic patients with an acute event of overt hepatic encephalopathy.

Materials and Methods

Type of study: Retrospective, transversal, observational, analytical, single-center.

Were included patients over 18 years of age, treated in the continuous admission service for acute event of manifest hepatic encephalopathy grade II to IV according to the West-Haven criteria, who received treatment based on L-ornihine L aspartate in a dose of 20 g. intravenous infusion for 4 hours, with evaluation of the response at the end of infusion. Study period: January 2022 to December 2023. Statistical analysis was performed with frequencies and percentages; For the quantitative variables Student's t or Mann-Whitney U according to the distribution of the variables and to show the difference between the degree of hepatic encephalopathy on admission and after the infusion of l-ornithine l-aspartate, Wilcoxon was used.

Results

72 patients with decompensated liver cirrhosis of any etiology were included, mostly Child-Pugh C functional class (56.9%), with a predominance of female sex (75%), and it was found that the most frequent triggering factor was constipation (22.2). %), followed by urinary tract infection (12.5%). Upon admission, the degree of encephalopathy was classified according to the West-Haven clinical scale of which grade II was the most prevalent, the single intravenous dose of L-ornithine, L-aspartate was effective with a significant response p< 0.05

Conclusions

The response to a single intravenous dose of 20 g of l-ornithine l-aspartate is effective for the treatment of hepatic encephalopathy, clinically manifesting in an acute episode.

Ethical statement: Risk-free research and approved by the ethics committee.

Declaration of interests: None.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Table 1.

Characteristics of patients with hepatic encephalopathy.

Age	59 (56.25 – 67.75)
Women	54 (75%)
Men	18 (25%)
Etiology
BPC	19 (26.4%)
MASLD	19 (26.4%)
Alcohol	11 (15.3%)
Child-Pugh C	41 (56.9%)
MELD	20 points (18.25-29)
WHC severity scale
Grade II	35 (48.6%)
Grade III	31 (43.1%)
Grade IV	6 (8.3%)
Precipitanting factors
Constipation	16 (22.2%)
UVI	9 (12.5%)
Unidentified	9 (12.5%)

BPC, Primary Biliary Cirrhosis; MASLD, Metabolic dysfunction–associated steatotic liver disease; UVI, Urinary Tract Infection.