Comparison 5.
Appearance of encephalopathy ‐ all studies
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 All studies | 23 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.1 All trials | 23 | 1062 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.65, 1.08] |
| 1.2 Standard amino acids | 11 | 339 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.86 [0.50, 1.48] |
| 1.3 BCAAs | 15 | 772 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.82 [0.63, 1.09] |
| 2 Parenteral nutrition ‐ all trials | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.1 All trials | 5 | 231 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.52 [0.21, 1.25] |
| 2.2 Standard amino acids | 3 | 87 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.38 [0.10, 1.48] |
| 2.3 BCAAs | 2 | 144 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.66 [0.21, 2.12] |
| 3 Parenteral nutrition ‐ medical trials | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3.1 All trials | 3 | 87 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.38 [0.10, 1.48] |
| 3.2 Standard amino acids | 3 | 87 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.38 [0.10, 1.48] |
| 3.3 BCAAs | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 4 Parenteral nutrition ‐ surgical trials | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 4.1 All trials | 2 | 144 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.66 [0.21, 2.12] |
| 4.2 Standard amino acids | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 4.3 BCAAs | 2 | 144 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.66 [0.21, 2.12] |
| 5 Enteral nutrition ‐ all studies | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 5.1 Standard amino acids | 4 | 91 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.73 [0.67, 4.45] |
| 5.2 BCAAs | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.36 [0.53, 10.55] |
| 6 Enteral nutrition ‐ medical trials | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.1 All studies | 4 | 102 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.33 [0.52, 3.44] |
| 6.2 Standard amino acids | 4 | 91 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.73 [0.67, 4.45] |
| 6.3 BCAAs | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.36 [0.53, 10.55] |
| 7 Enteral nutrition ‐ surgical trials | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 7.1 All trials | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 7.2 Standard amino acids | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 7.3 BCAAs | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 8 Supplements | 14 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 8.1 All trials | 14 | 734 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.61, 1.05] |
| 8.2 Standard amino acids ‐medical trials | 4 | 170 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.31, 1.57] |
| 8.3 BCAAs ‐ medical trials | 10 | 536 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.60, 1.05] |
| 8.4 All supplements ‐ medical | 12 | 666 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.61, 1.05] |
| 8.5 All surgical | 2 | 68 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 9 Medical trials all trials | 19 | 846 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.66, 1.11] |
| 9.1 Parenteral nutrition | 3 | 87 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.38 [0.10, 1.48] |
| 9.2 Enteral nutrition | 4 | 102 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.85 [0.75, 4.56] |
| 9.3 Supplements | 12 | 657 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.61, 1.06] |
| 10 Medical trials ‐ standard amino acids | 11 | 339 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.86 [0.50, 1.48] |
| 10.1 Parenteral nutrition | 3 | 87 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.38 [0.10, 1.48] |
| 10.2 Enteral nutrition | 4 | 91 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.73 [0.67, 4.45] |
| 10.3 Supplements | 4 | 161 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.74 [0.32, 1.67] |
| 11 Medical trials ‐ BCAAs | 11 | 560 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.64, 1.12] |
| 11.1 Parenteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 11.2 Enteral nutrition | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.36 [0.53, 10.55] |
| 11.3 Supplements | 10 | 536 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.60, 1.05] |
| 12 Surgical trials ‐ all studies | 4 | 212 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.66 [0.21, 2.12] |
| 12.1 Parenteral nutrition | 2 | 144 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.66 [0.21, 2.12] |
| 12.2 Enteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 12.3 Supplements | 2 | 68 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 13 Surgical trials ‐ standard amino acids | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 13.1 Parenteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 13.2 Enteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 13.3 Supplements | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 14 Surgical trials ‐ BCAAs | 4 | 212 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.66 [0.21, 2.12] |
| 14.1 Parenteral nutrition | 2 | 144 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.66 [0.21, 2.12] |
| 14.2 Enteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 14.3 Supplements | 2 | 68 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 15 Alcoholic hepatitis ‐ all studies | 6 | 172 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.19 [0.53, 2.68] |
| 15.1 Parenteral nutrition | 2 | 47 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.19 [0.01, 3.52] |
| 15.2 Enteral nutrition | 2 | 48 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.95 [0.57, 6.69] |
| 15.3 Supplements | 2 | 77 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.21 [0.32, 4.56] |
| 16 Alcoholic hepatitis ‐ standard amino acids | 6 | 161 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.06 [0.45, 2.50] |
| 16.1 Parenteral nutrition | 2 | 47 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.19 [0.01, 3.52] |
| 16.2 Enteral nutrition | 2 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.75 [0.45, 6.70] |
| 16.3 Supplements | 2 | 77 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.21 [0.32, 4.56] |
| 17 Alcoholic hepatitis ‐ BCAA | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.36 [0.53, 10.55] |
| 17.1 Parenteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 17.2 Enteral nutrition | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.36 [0.53, 10.55] |
| 17.3 Supplements | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 18 Cirrhosis ‐ all studies | 12 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.64, 1.08] |
| 18.1 Parenteral nutrition | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.5 [0.10, 2.43] |
| 18.2 Enteral nutrition | 2 | 54 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.71 [0.46, 6.44] |
| 18.3 Supplements | 9 | 326 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.62, 1.04] |
| 19 Cirrhosis ‐ standard amino acids | 6 | 229 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.53, 1.72] |
| 19.1 Parenteral nutrition | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.5 [0.10, 2.43] |
| 19.2 Enteral nutrition | 2 | 54 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.71 [0.46, 6.44] |
| 19.3 Supplements | 3 | 135 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.93 [0.44, 1.97] |
| 20 Cirrhosis ‐ BCAAs | 8 | 231 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.81 [0.63, 1.04] |
| 20.1 Parenteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 20.2 Enteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 20.3 Supplementss | 8 | 231 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.81 [0.63, 1.04] |
| 21 HCC ‐ all studies | 2 | 305 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.38, 1.48] |
| 21.1 Parenteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 21.2 Enteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 21.3 Supplements | 2 | 305 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.38, 1.48] |
| 22 HCC ‐ standard amino acids | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 22.1 Parenteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 22.2 Enteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 22.3 Supplements | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 23 HCC ‐ BCAAs | 2 | 305 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.38, 1.48] |
| 23.1 Parenteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 23.2 Enteral nutrition | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 23.3 Supplements | 2 | 305 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.38, 1.48] |
| 24 Abstracts excluded | 18 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 24.1 All trials | 18 | 659 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.64, 1.13] |
| 24.2 Standard amino acids | 7 | 201 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.89 [0.42, 1.86] |
| 24.3 BCAAs | 12 | 471 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.67, 1.16] |
| 24.4 Parenteral nutrition all | 5 | 231 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.52 [0.21, 1.25] |
| 24.5 Parenteral nutrition ‐ SAAs | 3 | 87 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.38 [0.10, 1.48] |
| 24.6 Parenteral nutrition ‐ BCAAs | 2 | 144 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.66 [0.21, 2.12] |
| 24.7 Enteral nutrition all | 2 | 48 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.95 [0.57, 6.69] |
| 24.8 Enteral nutrition ‐ SAAs | 2 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.75 [0.45, 6.70] |
| 24.9 Enteral nutrition ‐ BCAAs | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.36 [0.53, 10.55] |
| 24.10 Supplements all | 11 | 380 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.68, 1.13] |
| 24.11 Supplements ‐ SAAs | 2 | 77 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.21 [0.32, 4.56] |
| 24.12 Supplements ‐ BCAAs | 9 | 303 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.68, 1.03] |
| 25 Surgical trials ‐ transplant trials eliminated | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 25.1 All trials | 3 | 192 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.94 [0.25, 3.58] |
| 25.2 Standard amino acids | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 25.3 BCAAs | 3 | 192 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.94 [0.25, 3.58] |
| 26 ITT ‐ Parenteral nutrition ‐ best‐case scenario | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 26.1 All trials | 5 | 257 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.25 [0.11, 0.55] |
| 26.2 Standard amino acids | 3 | 87 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.38 [0.10, 1.48] |
| 26.3 BCAAs | 2 | 170 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.21 [0.08, 0.55] |
| 27 ITT ‐ Parenteral nutrition ‐ worst‐case scenario | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 27.1 All trials | 5 | 257 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.37 [0.70, 2.71] |
| 27.2 Standard amino acids | 3 | 87 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.38 [0.10, 1.48] |
| 27.3 BCAAs | 2 | 170 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.38 [0.99, 5.73] |
| 28 ITT ‐ Enteral nutrition ‐ best‐case scenario | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 28.1 All trials | 4 | 112 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.20 [0.53, 2.74] |
| 28.2 Standard amino acids | 4 | 101 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.07 [0.45, 2.52] |
| 28.3 BCAAs | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.36 [0.53, 10.55] |
| 29 ITT ‐ Enteral nutrition ‐ worst‐case scenario | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 29.1 All trials | 4 | 112 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.77 [1.23, 6.26] |
| 29.2 Standard amino acids | 4 | 101 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.78 [1.19, 6.48] |
| 29.3 BCAAs | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.36 [0.53, 10.55] |
| 30 ITT‐ Supplements ‐ best‐case scenario | 14 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 30.1 All trials | 14 | 782 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.47, 0.79] |
| 30.2 Standard amino acids ‐medical trials | 4 | 191 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.36 [0.18, 0.72] |
| 30.3 BCAAs ‐ medical trials | 10 | 559 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.52, 0.90] |
| 30.4 All supplements ‐ medical | 12 | 707 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.62 [0.48, 0.81] |
| 30.5 All surgical | 2 | 74 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.01, 3.97] |
| 31 ITT ‐ Supplements ‐ worst‐case scenario | 14 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 31.1 All trials | 14 | 781 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.18 [0.90, 1.54] |
| 31.2 Standard amino acids ‐medical trials | 4 | 191 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.57 [0.79, 3.13] |
| 31.3 BCAAs ‐ medical trials | 10 | 559 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.78, 1.35] |
| 31.4 All supplements ‐ medical | 12 | 707 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.11 [0.85, 1.45] |
| 31.5 All surgical | 2 | 74 | Risk Ratio (M‐H, Fixed, 95% CI) | 9.0 [0.51, 158.85] |