Achord 1987

Methods	Randomised trial comparing parenteral nutrition to no parenteral nutrition in hospitalized patients with alcoholic hepatitis. Geographical location: Jackson, Mississippi, USA. Paper published 1987.
Participants	Inclusion criteria: alcoholic hepatitis. Exclusion criteria: none cited. 40 hospitalized patients randomised, but demographics only available for the 28 who completed trial (23 male/5 female, mean age 46/51 in treatment/control groups).
Interventions	Intervention group received parenteral nutrition (21.25 g amino acids, 430 kcal/liter, 2 liters/day) + conventional diet; Controls received conventional diet (2675 kcal, 100 gm protein, 119 gm fat, 295 gm carbohydrates with salt restriction as needed). Duration therapy at least 21 days.
Outcomes	Mortality, appearance/resolution ascites, appearance/resolution hepatic encephalopathy, serum bilirubin (estimated from Figure 1A). One patient in parenteral nutrition group noted to have thrombophlebitis, but data regarding adverse events did not appear to have been systematically obtained.
Category of study	Parenteral nutrition/Medical.
Sample size calculation	Not reported if done.
Full paper or abstract only	Full paper.
Notes	Patients in parenteral nutrition group also given 10 mg cortisol/1000 IU heparin/d for thrombophlebitis prophylaxis; it was decided that these agents were not likely to impact on the clinical course. Request for further information sent to Dr Achord via US mail on September 12, 2011. (Address = James L Achord, MD, Emeritus Professor at University of Mississippi, University of Mississippi, P.O. Box 1848, University, MS 38677), but the letter returned as undeliverable.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Blind drawing of coded cards at time of assignment.
Allocation concealment (selection bias)	Low risk	Blind drawing of coded cards at time of assignment.
Blinding (performance bias and detection bias) All outcomes	High risk	Not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	7 dropouts in treatment group and 5 dropouts in control group all accounted for.
Selective reporting (reporting bias)	Low risk	Mortality and morbidity outcomes reported.
Other bias	Unclear risk	Funder of trial not reported.
Intent to treat analysis	High risk	Could not be done.
Baseline imbalance?	Low risk	No imbalance identified.
Early stopping?	Unclear risk	No sample size calculation and unknown why stopped.