Protein-calorie malnutrition is frequently observed in patients with advanced liver cirrhosis. There have been continued interests in potential benefits of long-term oral branched-chain amino acid supplement in improving severity of liver disease. However, there are limited evidences in literature. The aim of this study is to evaluate the efficacy of oral branched-chain amino acid in patients with advanced liver cirrhosis.

This study is a multicenter retrospective cohort study involving thirteen centers in Korea nation-wide. The inclusion criteria are liver cirrhosis patients with Child-Pugh score 8 to 10. The major exclusion criteria are abnormal serum creatinine level, and hepatocellular carcinoma with viable tumor. The investigators analyzed improvement of Model for End-Stage Liver Disease score, Child-Pugh score, incidence of cirrhosis-related complications, and event free survival.

Inclusion Criteria:

• Advanced liver cirrhosis patients with Child-Pugh score 8 to 10

Exclusion Criteria:

• Diagnosis of malignancy (except hepatocellular carcinoma) within 3 years or untreated malignancy
• Major organ failure (heart, lung and kidney) need to admission or medical therapy or dialysis
• Patients already on a waiting list or being considered for major organ transplantation.
• Serum creatinine above upper normal range (>1.5 mg/dL)
• Patients treating with albumin replacement regularly
• Viable hepatocellular carcinoma or advanced Barcelona Clinic Liver Cancer stage or hepatocellular carcinoma below 6 months life expectancy
• Patients being impossible to secession of alcohol consumption
• Patients being impossible to oral ingestion or oral medication
• Pregnancy or being considered for pregnancy
• Breast feeding
• Amyotrophic lateral sclerosis
• Patients with other metabolic disorder presenting branched-chain ketoaciduria