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

Abstract

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.