P3705 - Use of L-Ornithine L-Aspartate in Reducing Inpatient Hospital Length of Stay in Patients With Hepatic Encephalopathy: A Systematic Review and Meta-Analysis

Syed M. Alam, MD¹, Niloy Ghosh, MD¹, Jessica M. Gross, PhD², Swathi Paleti, MD¹
1University of New Mexico Health Sciences Center, Albuquerque, NM; 2University of New Mexico, Albuquerque, NM

Introduction: The efficacy of L-Ornithine L-Aspartate (LOLA) therapy in cirrhotic patients hospitalized for hepatic encephalopathy (HE) remains limited in evidence. This systematic review and meta-analysis aimed to evaluate whether LOLA therapy, compared to placebo, reduces the hospital length of stay (LOS) in these patients.

Methods: A systematic review and meta-analysis were conducted by screening 257 studies from two comprehensive online databases (Medline and Cochrane Library). Two independent investigators assessed abstracts for inclusion criteria. Ten studies underwent detailed review, and three met inclusion criteria for evaluating the effect of LOLA therapy on hospital LOS compared to placebo.

Results: A total of 413 patients were included across the three studies, with 208 patients receiving intravenous LOLA therapy and 205 receiving placebo. A random-effects meta-analysis was performed to assess the difference in hospital LOS between the two groups. The pooled mean difference was −2.21 days (95% CI: −4.97, 0.55), suggesting a trend toward shorter stays with LOLA therapy, though this was not statistically significant (z=−1.57, p=0.116). Substantial heterogeneity was observed (I²=83.35%, τ²=4.77), with significant variability between studies (Q(2)=13.64, p=0.001). These findings indicate potential reductions in hospital LOS but highlight variability that limits the certainty of the effect.

Discussion: LOLA therapy shows a potential trend toward reducing hospital LOS in cirrhotic patients admitted for HE. However, the results were not statistically significant, and substantial heterogeneity limits definitive conclusions. Further robust, large-scale studies are warranted to confirm whether LOLA can effectively reduce LOS in these patients.


Figure: Figure 1: a) Length of Stay (LOS) Forest plot with all studies included; b) LOS forest plot excluding Jain et al (provides statistical significance)


Figure: Figure 2: Hepatic Encephalopathy Resolution with LOLA

Disclosures:
Syed Alam indicated no relevant financial relationships.
Niloy Ghosh indicated no relevant financial relationships.
Jessica Gross indicated no relevant financial relationships.
Swathi Paleti indicated no relevant financial relationships.

Syed M. Alam, MD¹, Niloy Ghosh, MD¹, Jessica M. Gross, PhD², Swathi Paleti, MD¹. P3705 - Use of L-Ornithine L-Aspartate in Reducing Inpatient Hospital Length of Stay in Patients With Hepatic Encephalopathy: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.