Efficacy of L-Ornithine L-Aspartate in Acute Hepatic Encephalopathy.
- Conditions
- Hepatic Encephalopathy
- Interventions
- Registration Number
- NCT01041755
- Lead Sponsor
- Centro Regional para el Estudio de las Enfermedades Digestivas
- Brief Summary
Hepatic encephalopathy is caused by the effects on the brain of substances that under normal circumstances are efficiently metabolized in the liver. The hyperammonemia is the main factor responsible for the development of hepatic encephalopathy. In patients with cirrhosis, the reduction in hepatocellular function and generation of portosystemic shunts contribute to increase serum ammonium. The current therapeutic approaches, are aimed at reducing blood ammonium levels.
Administration of the non-absorbable disaccharides, have become standard treatment of hepatic encephalopathy.There are no adequate clinical trials comparing the efficacy of L-Ornithine-L-Aspartate (LOLA) infusion against lactose enemas in the treatment of acute hepatic encephalopathy.
- Detailed Description
The main impact of hepatic encephalopathy in patients with cirrhosis is not related to costs, but its association with decreased survival and quality of life and should therefore clearly established the effectiveness of therapeutic interventions used in this disorder.
At the end of the nineteenth century to the ammonium was identified as the main agent responsible for the development of the syndrome of hepatic encephalopathy. Since then, reduced nitrogen compounds from the intestine are considered the main therapeutic measure. On this conceptual base, nonabsorbable disaccharides are the first line therapy in hepatic encephalopathy.
Current knowledge indicates that other organs such as muscle, brain and kidney are involved in the generation of ammonium, which has set the pace for the development of new treatments, able to act systemically in metabolism and elimination of ammonia . L-ornithine L-aspartate (LOLA) lowers ammonium concentrations in animal and humans models with hyperammonemia. There are no adequate clinical trials comparing the efficacy of LOLA infusion against lactose enemas in the treatment of acute hepatic encephalopathy.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 30
- Patients with cirrhosis of any etiology, diagnosed by ultrasound,clinical and / or histologic criteria
- Patients over 18 years and under 75
- Patients with hepatic encephalopathy grade 3-4 according to the criteria of West Haven
- Patients with hyperammonemia >10 µmol/l
- Evidence of neurological or psychiatric illness
- Use of drugs affecting the central nervous system
- Withdrawal Syndrome
- Anorectal disease that interferes with the administration of enemas
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Lactose enemas Lactose b) 20% Lactose enemas Intravenous infusion of L- Ornithine L- Aspartate L-ornithine-L-aspartate a) 20 g L-ornithine-L-aspartate
- Primary Outcome Measures
Name Time Method Improvement of at least one grade in mental state based on the West Haven Criteria 72 hours Improvement was assessed at 0, 24, 48 and 72 hours. The mental state was scored from trivial lack of awareness to deep coma from grade 1 to grade 4.
- Secondary Outcome Measures
Name Time Method Improvement in serum ammonia 72 hours Ammonia determination was performed at 0, 24, 48 and 72 hours.
Improvement of at least one grade in mental state assessed by the Glasgow Coma Scale 72 hours Improvement was assessed at 0, 24, 48 and 72 hours. The Glasgow Coma Scale assesses three aspects of responsiveness: eye-opening, motor, and verbal responses. The eye-opening was quantified from 1 to 4 points, the motor response from 1 to 6 points and the verbal response from 1 to 5 points.
Improvement of at least one grade in mental state assessed by the Clinical Hepatic Encephalopathy Staging Scale (CHESS) 72 hours Improvement was assessed at 0, 24, 48 and 72 hours. The CHESS scale has 9 dichotomous questions that assess mental state, intellectual function, behavior, verbal and motor response and orientation. It was quantified from 0 to 9 points.
Improvement of asterixis grade 72 hours Improvement was assessed at 0, 24, 48 and 72 hours. Asterixis was graded as follows: Grade 0 = without flapping motion, Grade 1 ≤ 5 flaps per minute, Grade 2 = 6 to 10 flaps per minute, Grade 3 = 11 to 20 flaps per minute and Grade 4, continuous flap or patient in coma unable to maintain wrist dorsiflexion. Asterixis grade was evaluated at 0. 24, 48 and 72 hours.
Improvement in electroencephalographic tracing grade 72 hours Improvement was assessed at 0 and 72 hours. EEG tracing was graduated from 0 to 4: Grade 0 = normal alpha rhythm, Grade 1 =7 to 8 cycles per second, Grade 2= 5 to 6 cycles per second, Grade 3 = 3 to 4.5 cycles per second and Grade 4 \< than 3 cycles per second or delta rhythm. EEG was assessed at 0 and 72 hours.
Improvement in Number connection tests 72 hours The mental state of the patients included in the study did not allow them to perform the number connection test, therefore, they were all assigned to the worst score (Grade 4)
Improvement in Portosystemic Encephalopathy Index. 72 hours Improvement was assessed at 0 and 72 hours. The PSE Index was calculated by multiplying the grade of mental state by a factor of 3; and the grades of asterixis, number connection tests, serum ammonia and EEG were multiplied times a factor of 1. The results were divided by the maximal possible PSE sum.
Trial Locations
- Locations (1)
Hospital Universitario "José Eleuterio González"
🇲🇽Monterrey, Nuevo León, Mexico