Effect of L‑carnitine on health‑related quality of life in patients with liver cirrhosis

L‑carnitine (4‑N‑trimethylammonium‑3‑hydroxybutyric acid) is the physiologically active form of carnitine and is a natural compound that has been shown to exhibit antioxidant activity. L‑carnitine is used as a supplementary treatment in patients with cirrhosis with hepatic encephalopathy, hyperammonemia or muscle cramps. In the present study, the effect of L‑carnitine supplementation on health‑related quality of life in 30 patients with cirrhosis was prospectively examined. L‑carnitine (1,800 mg/day) was administered orally for 6 months. To assess the effects of L‑carnitine on chronic fatigue, patients filled out a self‑report questionnaire regarding their physical and mental health. The levels of total and free carnitine, and acylcarnitine were found to be significantly higher 1, 3 and 6 months after therapy initiation compared with before treatment. Serum albumin levels were significantly increased 3 and 6 months after initiation of therapy. L‑carnitine supplementation significantly increased the BAP/d‑ROM ratio, a marker of antioxidant status in patients with cirrhosis. Changes in serum carnitine concentrations were positively correlated with changes in serum albumin levels (R2=0.369; P=0.012), but not with changes in serum ammonia levels (R2= 0.005; P=0.78). Total and mental health scores improved significantly, and physical scores improved marginally 3 and 6 months after initiation of L‑carnitine. These findings may be attributed to the enhanced serum albumin levels and oxidative stress rather than the reduced serum ammonia levels. Based on these results, it is suggested that L‑carnitine can potentially alleviate chronic fatigue, along with the increased BAP/d‑ROM ratio, which were involved in increased oxidative stress in patients with cirrhosis. The specific mechanisms by which L‑carnitine ameliorates chronic fatigue is not fully understood and requires further investigation.