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Oral Acetyl-L-Carnitine treatment in hepatic encephalopathy: view of evidence-based medicine

Qian Jiang, Gang Jiang, Ke-Qing Shi, Hong Cai, Yi-xin Wang, Ming-hua Zheng


Objective. To systematically review the effect of Acetyl-L-Carnitine in patients with hepatic encephalopathy. Material and methods. Design: systematic review and meta-analysis. Data sources: The Cochrane Library, MEDLINE,, Science Citation Index, Google search and the China Biological Medicine Database to June 2012. Review methods: randomized placebo controlled trials of Acetyl-L-Carnitine in patients with hepatic encephalopathy assessing whether Acetyl-L-Carnitine an effective therapy or not. No language restrictions were applied. Two reviewers independently extracted data and assessed quality. Results. 7 methodologically sound randomized controlled trials were identified involving 660 participants with hepatic encephalopathy, totaling 249 with subclinical hepatic encephalopathy, 189 with West Haven grade 1, 162 with West Haven grade 2 and 60 with West Haven grade 3. Acetyl-L-Carnitine was effective to improve serum ammonia level (weighted mean difference 25.90, 95% confidence intervals 20.89 to 30.91, P < 0.05) and the number connection test completion time (weighted mean difference 16.62, 95% confidence intervals 9.88 to 23.36, P < 0.05). The outcome was consistent in subgroup analyses. No publication bias was detected. Adverse events were reported infrequently and were minor. Conclusions. Acetyl-L-Carnitine is promising as an effective and tolerable treatment for hepatic encephalopathy that associated with improved serum ammonia levels and the number connection test.

Key words. Carnitine, Ammonia, Randomized controlled trial, Meta-analysis

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The Official Journal of the Mexican Association of Hepatology, the Latin-American Association for the Study of the Liver and the Canadian Association for the Study of the Liver

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