Survival benefit of L-carnitine supplementation in patients with cirrhosis

Background: L-carnitine supplementation is effective in improving cirrhotic complications. However, limited evidence is available on the effect of L-carnitine supplementation on the survival of patients with cirrhosis.
Methods: This retrospective study included 581 patients with cirrhosis admitted between October 2011 and December 2018. L-carnitine supplementation was defined as the use of L-carnitine for more than 30 consecutive days. Propensity score matching was applied to compare L-carnitine-treated and untreated patients. Mortality was evaluated using the Cox proportional hazards model.
Results: Among the 581 patients, 71 (12%) received L-carnitine supplementation. Propensity matching identified 189 patients (63 L-carnitine-treated and 126 untreated patients). Of the matched patients, 33 (52%) L-carnitine-treated and 74 (59%) untreated patients died during the median follow-up period of 36.3 months. Overall survival was significantly higher in L-carnitine-treated patients than in untreated patients (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.43–0.99). A subgroup analysis showed that the survival benefit of L-carnitine supplementation was prominent in patients with Child-Pugh class B or C (HR, 0.39; 95% CI, 0.23–0.68), albumin levels ≤3.5 g/dL (HR, 0.59; 95% CI, 0.37–0.95), and ammonia levels ≥90 μg/dL (HR, 0.50; 95% CI, 0.26–0.97) and those without sarcopenia (HR, 0.56; 95% CI, 0.35–0.90).
Conclusion: L-carnitine supplementation may improve survival in patients with cirrhosis.