Efficacy of L-Ornithine L-Aspartate (LOLA) as an Adjunct to Branched Chain Amino Acids (BCAA) Enriched Solutions on Clinical Outcomes in ICU Patients with Hepatic Encephalopathy: A Randomized Controlled Trial

Abstract Background Hepatic encephalopathy or portosystemic encephalopathy is a syndrome describing a spectrum of potentially reversible neuropsychiatric abnormalities, occurring as a complication of severe acute or chronic liver insufficiency, large portal-systemic shunts, or both. Aim of the Work To assess the efficacy of LOLA as an adjunct to BCAA enriched solutions on reversal of HE or improvement of HE by two grades (according to West Havens Criteria) and mental state grade after 5 days of treatment in ICU patients. Patients and Methods This study is randomized Controlled Trial, the study was conducted on patients with grade III / IV hepatic encephalopathy who will be admitted to internal medicine ICU of Ain Shams university hospitals Results The need for vasopressor support with mean duration of therapy (11 (16.9%) in group I and 22 (33.3%) in group II), the need for renal replacement therapy (RRT) during ICU stay (7 (10.8%) in group I and 17 (25.8%) in group II), length of hospital stay (19.4±3.0 24.8±4.1), and length of ICU stay (11.8±3.4 in group I and 17.2±3.9 in group II) were all assessed in our trial and found to be significantly lower in patients receiving LOLA infusion, in our trial, all these effects occurred more frequently in group I, suggesting that they might be related to LOLA (P > 0.05), our clinical trial was conducted to assess the efficacy of LOLA plus BCAA and conventional therapy in overt hepatic encephalopathy patients against BCAA and conventional therapy alone. Results support the efficacy of LOLA proven by its capability of the reversal of hepatic encephalopathy and better short-term survival rates. Conclusion The results of this prospective double-blind controlled trial demonstrate the efficacy of L-ornithine L-aspartate (LOLA) as an adjunct to branched-chain amino acids (BCAA) and conventional therapy in patients with overt hepatic encephalopathy (HE). Patients receiving LOLA showed significant improvements in neurological function, including higher Glasgow Coma Scale scores, and a remarkable reduction in HE grades, with almost 90% experiencing either improvement or resolution of HE.