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Additional L-Carnitine Reduced the Risk of Hospitalization in Patients with Overt Hepatic Encephalopathy on Rifaximin.

  • 2021-06-28
  • Digestive diseases (Basel, Switzerland) 40(3)
    • Kousuke Kubota
    • Haruki Uojima
    • Xue Shao
    • Shuichiro Iwasaki
    • Hisashi Hidaka
    • Naohisa Wada
    • Takahide Nakazawa
    • Akitaka Shibuya
    • Makoto Kako
    • Wasaburo Koizumi

Study Design

Type
Randomized Controlled Trial (RCT)
Sample size
n = 42
Population
83 patients with hepatic encephalopathy receiving rifaximin
Methods
Randomized, 12-week treatment period; patients received either rifaximin 1,200 mg/day (group A) or L-carnitine 1,500 mg/day plus rifaximin 1,200 mg/day (group B)
Duration
12 weeks
Funding
Unclear

Background

Data regarding the additional effect on the recurrence of hepatic encephalopathy (HE) after oral L-carnitine administration are scarce.

Objective

This study aimed to assess the additional effects of L-carnitine in patients who were receiving rifaximin for HE.

Methods

This randomized study comprised a screening visit and a 12-week treatment period. Patients who fulfilled the eligibility criteria were randomized to either group A (additional rifaximin) or group B (additional L-carnitine and rifaximin). Group A received 1,200 mg/day of rifaximin. Group B received 1,500 mg/day of L-carnitine and rifaximin at 1,200 mg/day. The endpoints were the changes in the portal systemic encephalopathy (PSE) index and the admission rate from the baseline for the duration of the study in both groups.

Results

Eighty-three patients were randomized to either group A (n = 42) or group B (n = 41). In group A, the PSE index decreased from 0.35 ± 0.09 at baseline to 0.27 ± 0.11 on the final evaluation day (p = 0.001). In group B, the PSE index decreased from 0.37 ± 0.09 at baseline to 0.24 ± 0.11 on the final evaluation day (p = 0.001). Although there was not a significant reduction in the PSE index in group A compared to that in group B (p = 0.202), the admission rates were 30.9% and 9.8% in groups A and B, respectively. Additional L-carnitine significantly reduced the admission rate (p = 0.028).

Conclusion

L-Carnitine addition reduced the risk of hospitalization for patients who received rifaximin for HE.

Research Insights

  • L-Carnitine→Reduced Hospitalization Rate

    the admission rates were 30.9% and 9.8% in groups A and B, respectively. Additional L-carnitine significantly reduced the admission rate (p = 0.028).

    Effect
    Beneficial
    Effect size
    Large
    Dose
    1,500 mg/day
  • L-Carnitine→Reduced PSE Index

    Although there was not a significant reduction in the PSE index in group A compared to that in group B (p = 0.202)

    Effect
    Neutral
    Effect size
    Small
    Dose
    1,500 mg/day
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