Efficacy of L-Ornithine L-Aspartate for the prevention and Treatment of Hepatic Encephalopathy in Cirrhosis: An Update of the Evidence Base
Bibliographic record
Abstract
The advent of well-established procedures for the determination of clinical trial quality based on risk of bias assessments has resulted insubstantial improvements in the quality of systematic reviews and meta-analyses relating to the assessment of Randomized Controlled Trials (RCTs) on the efficacy of treatments for a range of clinical conditions.In the current review, manual and electronic searches of databases using appropriate keywords were used to assess the evidence base for the use of L-ornithine L-aspartate (LOLA) for the prevention and treatment of Hepatic Encephalopathy (HE), a common neuropsychiatric complication of liver cirrhosis.Making use of current risk of bias techniques, seven systematic reviews with accompanying meta-analyses were identified in which the results of RCTs on the efficacy of LOLA for the treatment of HE were analyzed.A clear consensus of opinion was observed in support of the efficacy of LOLA for lowering of blood ammonia and for the concomitant improvement of mental status in patients with overt HE (OHE) and in five of the six meta-analyses in patients with minimal HE (MHE).Evidence in support of a beneficial effect of LOLA for the prevention of OHE in patients with cirrhosis was reported in a novel systematic review and meta-analysis involving the analysis of six RCTs in patients with cirrhosis and a range of clinical presentations where successful OHE prevention/prophylaxis was accompanied in all cases by significant reductions of blood ammonia.Both, intravenous and oral formulations of LOLA were found to be effective.Reduction in the progression of MHE to OHE was independently confirmed in a subsequent meta-analysis.Two systematic reviews with network meta-analyses compared the efficacy of LOLA to other available agents.Only treatment with LOLA or branched-chain amino acids (BCAAs) resulted in significant improvements in mental status and LOLA was judged to be the most effective agent with respect to clinical improvement and concomitant reduction of blood ammonia.In the case of MHE, rifaximin, lactulose and LOLA were equivalent in clinical efficacy and were each superior to probiotics.LOLA was superior to lactulose or probiotics for the prevention of episodes of OHE in patients with MHE compared to placebo/no treatment; rifaximin was ineffective in this regard.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.033 | 0.056 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.008 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".