Short-term effects of branched-chain amino acids on liver function tests in cirrhotic patients.

A randomized study was conducted in 29 ambulatory cirrhotic patients to determine the short-term effects of branched-chain amino acids (BCAA) on nutritional status, biochemical liver function tests and caffeine clearance. Each patient received a 4-week period of isonitrogenous and isocaloric regimens, either a standardized diet contained 40 g protein with supplementation of BCAA 150 g daily (group I) or only a standardized diet contained 80 g protein daily (group II). At the end of treatment, only group I showed significant improvements in transaminase levels as well as the caffeine clearance test compared with those of the pre-treatment levels. Nonetheless, significant improvements in nutritional parameters and additional liver function tests were not yet detected. We conclude that the short-term nutritional supplementation of BCAA is well tolerated and leads to improvement in hepatic metabolic capacity assessed by the caffeine clearance test.

A risk scoring system to predict outcome of non-variceal upper gastrointestinal bleeding in Thai patients.

The purpose of this study was to determine the predictors for poor outcome in patients with upper gastrointestinal bleeding (UGIB) by constructing a risk-scoring system based on retrospective data analysis and validating the scoring system prospectively. In the first phase of the study, 264 patients with acute non-variceal UGIB were retrospectively reviewed, and likely predictors of poor outcome, including major re-bleeding, need for emergency surgery to control bleeding and hospital death, were ranked into a risk scoring system. In the second phase, this scoring system was prospectively validated in 107 patients. The characteristics of the retrospective and the prospective groups were not significantly different. Four predictors of outcome were found to be significant, namely concurrent illnesses, the presence of at least one disease (score 1), heart rate above 110 beat/min (score 1), blood transfusion over 6 units (score 2) and the presence of visible vessels on endoscopic examination (score 1). Patients with a total score of less than 2 had good outcome whereas scores of 2 or more were associated with a poor outcome. The accuracy of the test was 82.5 per cent. The positive and negative predictive values were 46.3 per cent and 92.7 per cent respectively. The likelihood ratio was 4.5. It is concluded that the risk scoring system constructed in this study represents a good predictor of poor clinical outcome in patients presenting with non-variceal UGIB.