The BCAA/AAA ratio of plasma amino acids in three different groups of cirrhotics.

We studied the plasma amino acid profiles in the postabsorptive period in three groups of cirrhotic patients: stable, unstable, and with acute portal systemic encephalopathy (PSE), and compared them with a healthy control group in order to investigate the differences among the different groups and reevaluate the use of the branched-chain amino acid/aromatic amino acid (BCAA/AAA) ratio. Although plasma amino acid levels were similar to the control group, stable cirrhotics had a significantly decreased BCAA/AAA ratio (2.9 +/- 0.2) compared to the control group (3.9 +/- 0.3) (p < 0.05). Unstable cirrhotics had differences in plasma amino acid levels and the BCAA/AAA ratio was even lower (1.7 +/- 0.3) compared with stable cirrhotics and controls, respectively (p < 0.05 and p < 0.01). Patients with PSE had extreme elevations of most amino acids and showed the lowest BCAA/AAA ratio of all four groups (0.8 +/- 0.07) (p < 0.001 compared with controls). We conclude that it is possible to detect differences in plasma amino acid concentrations in different groups of cirrhotics, and that the BCAA/AAA ratio is a good index for the assessment of liver impairment. The latter could be used in the follow-up of a selected group of patients such as those undergoing major surgery or liver transplantation in whom the BCAA/AAA ratio could be used to help determine the best time for the transplant.