Cochrane · systematic review · CD012410
L‐ornithine L‐aspartate for prevention and treatment of hepatic encephalopathy in people with cirrhosis
Goh, ET, Stokes, CS, Sidhu, SS, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Hepato-BiliaryAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
20
current version
GRADE rated
16
No studies
4
Included studies
NR
No studies 4 · 20%Ungraded 0 · 0%Very low 16 · 80%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
L‐ornithine L aspartate compared to placebo or no intervention for people with cirrhosis and hepatic encephalopathy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality L‐ornithine L aspartate vs placebo or no intervention | RR 0.42 [0.24, 0.72] | 19 studies · 1489 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Hepatic encephalopathy assessed based on neurocognitive manifestations L‐ornithine L aspartate vs placebo or no intervention | RR 0.7 [0.59, 0.83] | 22 studies · 1375 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Serious adverse events assessed using ICH‐GCP L‐ornithine L aspartate vs placebo or no intervention | RR 0.63 [0.45, 0.9] | 19 studies · 1489 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Quality of life assessed using 3 different questionnaires L‐ornithine L aspartate vs placebo or no intervention | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Non‐serious adverse events assessed using ICH‐GCP L‐ornithine L aspartate vs placebo or no intervention | RR 1.15 [0.75, 1.77] | 14 studies · 1076 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
L‐ornithine L‐aspartate compared to lactulose for people with cirrhosis and hepatic encephalopathy
Population: people with cirrhosis who had minimal or overt hepatic encephalopathy or who were at risk for developing hepatic encephalopathy; regardless of sex, age, aetiology, and severity of the underlying liver disease or the presence of identified precipitating factors
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality L‐ornithine L‐aspartate vs lactulose | RR 0.68 [0.11, 4.17] | 4 studies · 175 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Hepatic encephalopathy assessed based on neurocognitive manifestations L‐ornithine L‐aspartate vs lactulose | RR 1.13 [0.81, 1.57] | 4 studies · 175 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Serious adverse events assessed using ICH‐GCP L‐ornithine L‐aspartate vs lactulose | RR 0.69 [0.22, 2.11] | 3 studies · 144 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Quality of life assessed using questionnaires L‐ornithine L‐aspartate vs lactulose | no estimate extracted | NR | No studies |
Non‐serious adverse events assessed using ICH‐GCP L‐ornithine L‐aspartate vs lactulose | RR 0.05 [0.01, 0.18] | 2 studies · 292 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
L‐ornithine L‐aspartate compared to probiotic for people with cirrhosis and hepatic encephalopathy
Population: people with cirrhosis who had minimal or overt hepatic encephalopathy or who were at risk for developing hepatic encephalopathy; regardless of sex, age, aetiology, and severity of the underlying liver disease, or the presence of identified precipitating factors
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality L‐ornithine L‐aspartate vs probiotic | RR 1.01 [0.11, 9.51] | 2 studies · 143 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Hepatic encephalopathy assessed based on neurocognitive manifestations L‐ornithine L‐aspartate vs probiotic | RR 0.71 [0.56, 0.9] | 2 studies · 143 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Serious adverse events assessed using ICH‐GCP L‐ornithine L‐aspartate vs probiotic | RR 1.07 [0.23, 4.88] | 2 studies · 143 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Quality of life assessed using questionnaires L‐ornithine L‐aspartate vs probiotic | no estimate extracted | NR | No studies |
Non‐serious adverse events assessed using ICH‐GCP L‐ornithine L‐aspartate vs probiotic | no estimate extracted | NR | No studies |
L‐ornithine L‐aspartate compared to rifaximin for people with cirrhosis and hepatic encephalopathy
Population: people with cirrhosis who had minimal or overt hepatic encephalopathy or who were at risk for developing hepatic encephalopathy; regardless of sex, age, aetiology, and severity of the underlying liver disease, or the presence of identified precipitating factors
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality L‐ornithine L‐aspartate vs rifaximin | RR 0.33 [0.04, 3.03] | 2 studies · 105 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Hepatic encephalopathy assessed based on neurocognitive manifestations L‐ornithine L‐aspartate vs rifaximin | RR 1.06 [0.57, 1.96] | 2 studies · 105 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Serious adverse events assessed using ICH‐GCP L‐ornithine L‐aspartate vs rifaximin | RR 0.32 [0.01, 7.42] | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Quality of life assessed using questionnaires L‐ornithine L‐aspartate vs rifaximin | no estimate extracted | NR | No studies |
Non‐serious adverse events assessed using ICH‐GCP L‐ornithine L‐aspartate vs rifaximin | RR 0.32 [0.01, 7.42] | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision, publication bias |