Survival benefit of <scp>l</scp>‐carnitine supplementation in patients with cirrhosis

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p><jats:sc>l</jats:sc>‐Carnitine supplementation is effective in improving muscle cramps, hyperammonemia, and hepatic encephalopathy in patients with cirrhosis. However, limited evidence is available on the effect of <jats:sc>l</jats:sc>‐carnitine supplementation on the survival of patients with cirrhosis.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In this retrospective study, 674 patients with cirrhosis admitted to Gifu University Hospital or Chuno Kosei Hospital between October 2011 and December 2018 were enrolled. <jats:sc>l</jats:sc>‐carnitine supplementation was defined as the use of <jats:sc>l</jats:sc>‐carnitine for >30 consecutive days during the follow‐up period. Propensity score matching was applied to create comparable groups between <jats:sc>l</jats:sc>‐carnitine–treated and untreated patients. Mortality was evaluated using the Cox proportional hazards model.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among the patients, 93 were excluded. Of the remaining 581 patients, 71 (12%) received <jats:sc>l</jats:sc>‐carnitine supplementation. Propensity matching identified 189 patients (63 <jats:sc>l</jats:sc>‐carnitine–treated and 126 untreated patients) with comparable baseline characteristics in both groups. Of the matched patients, 33 (52%) <jats:sc>l</jats:sc>‐carnitine–treated and 74 (59%) untreated patients died during the median follow‐up period of 36.3 months. Overall survival was significantly higher in <jats:sc>l</jats:sc>‐carnitine–treated patients than in untreated patients (hazard ratio [HR], 0.66; 95% CI, 0.43–0.99). A subgroup analysis showed that the survival benefit of <jats:sc>l</jats:sc>‐carnitine supplementation was prominent in patients with Child‐Pugh Class B or C (HR, 0.39; 95% CI, 0.23–0.68), serum albumin levels ≤3.5 g/dl (HR, 0.59; 95% CI, 0.37–0.95), and ammonia levels ≥90 mcg/dl (HR, 0.50; 95% CI, 0.26–0.97), and in those without sarcopenia (HR, 0.56; 95% CI, 0.35–0.90).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p><jats:sc>l</jats:sc>‐Carnitine supplementation may improve survival in patients with cirrhosis.</jats:p></jats:sec>