Role of Branched Chain Amino Acids in Cellular and Organ Damage: The Prognostic Significance of the Preoperative Branched Chain Amino Acid to Tyrosine Ratio

Abstract

Amino acid (AA) ratios are indicative of the systemic balance between protein metabolism and catabolism. The question arises as to whether particular AA ratios reflect the severity of liver damage. This chapter examines the relationship between preoperative AA ratios and liver function in hepatocellular carcinoma (HCC) patients. In addition, we discuss the clinical value of AA ratios in HCC patients who elect to undergo surgery. The branched-chain amino acid to tyrosine ratio (BTR) is an alternative indicator for Fischer’s ratio. The correlation between the Fischer’s ratio and the BTR is very high. In addition, the correlation between the BTR and other liver functional indicators varied depending on the severity of the patient’s liver disease. The BTR was not only able to predict the risk of complications but also predicted the severity of complications after initial hepatectomy for HCC. Furthermore, BTR was able to predict both recurrence free-survival (RFS) and overall survival (OS). The BTR-ALB classification could be used to identify patient groups that would benefit from branched-chain amino acid (BCAA) supplementation as adjuvant nutritional support.