Intravenous Branched Chain Amino Acids for Hepatic Encephalopathy in ACLF

Acute on chronic liver failure (ACLF) is a distinct clinical entity in the spectrum of chronic liver disease associated with high short term mortality. Hepatic encephalopathy (HE) is commonly seen in patients with ACLF and its treatment mainly involves non-absorbable disaccharides (lactulose/lactitol).Treatment of HE in ACLF is based on extrapolation of data available from cirrhotic patients. No studies have compared different treatment options for HE in patients with ACLF.

Inclusion criteria

• Age 18-75 years
• Either gender
• Patients with ACLF (CANONIC definition) of any aetiology with HE ≥grade 2 as per West-Haven Criteria or Hepatic encephalopathy scoring algorithm (HESA)

Exclusion criteria

• Those who do not consent to participate in the study
• Patients with structural brain lesions or stroke
• Inability to obtain informed consent from patient or relatives
• Severe preexisting cardiopulmonary disease
• Renal dysfunction (S. Creatinine ≥ 2mg/dL)
• Pregnancy/Lactation
• Post liver transplant patients
• HIV infection
• Patients who are on psychoactive drugs, like sedatives or antidepressants
• Patients who are too sick to carry out the protocol

As the study was carried out during the peak of the COVID-19, patients who developed COVID-19 after randomization were excluded from the analysis as they were shifted to dedicated COVID-19 ICU's.