Effect of rifaximin on infections, acute-on-chronic liver failure and mortality in alcoholic hepatitis: A pilot study (RIFA-AH)
Por:
Jimenez, C, Ventura-Cots, M, Sala, M, Calafat, M, Garcia-Retortillo, M, Cirera, I, Canete, N, Soriano, G, Poca, M, Simon-Talero, M, Altamirano, J, Lucey, M, Garcia-Tsao, G, Brown, RS, Schwabe, RF, Verna, EC, Schnabl, B, Bosques-Padilla, F, Mathurin, P, Caballeria, J, Louvet, A, Shawcross, DL, Abraldes, JG, Genesca, J, Bataller, R, Vargas, V
Publicada:
1 may 2022
Ahead of Print:
1 mar 2022
Resumen:
Background & Aims Alcoholic hepatitis (AH) is associated with a high incidence of infection and mortality. Rifaximin reduces bacterial overgrowth and translocation. We aimed to study whether the administration of rifaximin as an adjuvant treatment to corticosteroids decreases the number of bacterial infections at 90 days in patients with severe AH compared to a control cohort. Methods This was a multicentre, open, comparative pilot study of the addition of rifaximin (1200 mg/day/90 days) to the standard treatment for severe AH. The results were compared with a carefully matched historical cohort of patients treated with standard therapy and matching by age and model of end-stage liver disease (MELD). We evaluated bacterial infections, liver-related complications, mortality and liver function tests after 90 days. Results Twenty-one and 42 patients were included in the rifaximin and control groups respectively. No significant baseline differences were found between groups. The mean number of infections per patient was 0.29 and 0.62 in the rifaximin and control groups, respectively (p = .049), with a lower incidence of acute-on-chronic liver failure (ACLF) linked to infections within the treatment group. Liver-related complications were lower within the rifaximin group (0.43 vs. 1.26 complications/patient respectively) (p = .01). Mortality was lower in the treated versus the control groups (14.2% vs. 30.9, p = .15) without significant differences. No serious adverse events were associated with rifaximin treatment. Conclusions Rifaximin is safe in severe AH with a significant reduction in clinical complications. A lower number of infections and a trend towards a lower ACLF and mortality favours its use in these patients.
Filiaciones:
Jimenez, C:
Vall dHebron Hosp Univ, Liver Unit, Barcelona, Spain
Univ Autonoma Barcelona, Vall dHebron Inst Recerca, Dept Med, Liver Unit, Barcelona, Spain
Ventura-Cots, M:
Vall dHebron Hosp Univ, Liver Unit, Barcelona, Spain
Univ Autonoma Barcelona, Vall dHebron Inst Recerca, Dept Med, Liver Unit, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Univ Pittsburgh, Med Ctr, Ctr Liver Dis, Pittsburgh Liver Res Ctr,Div Gastroenterol Hepato, Pittsburgh, PA USA
Sala, M:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Badalona Germans Trias & Pujol, Gastroenterol Dept, Badalona, Spain
Calafat, M:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Badalona Germans Trias & Pujol, Gastroenterol Dept, Badalona, Spain
Garcia-Retortillo, M:
Univ Autonoma Barcelona, Hosp Mar, IMIM Hosp Mar Med Res Inst, Liver Sect,Gastroenterol Dept, Barcelona, Spain
Cirera, I:
Univ Autonoma Barcelona, Hosp Mar, IMIM Hosp Mar Med Res Inst, Liver Sect,Gastroenterol Dept, Barcelona, Spain
Canete, N:
Univ Autonoma Barcelona, Hosp Mar, IMIM Hosp Mar Med Res Inst, Liver Sect,Gastroenterol Dept, Barcelona, Spain
Soriano, G:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp La Santa Creu & St Pau, Dept Gastroenterol, Barcelona, Spain
Inst Invest Biomed St Pau IIB St Pau, Gastroenterol, Barcelona, Catalunya, Spain
Univ Autonoma Barcelona, Med, Barcelona, Catalunya, Spain
Poca, M:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp La Santa Creu & St Pau, Dept Gastroenterol, Barcelona, Spain
Inst Invest Biomed St Pau IIB St Pau, Gastroenterol, Barcelona, Catalunya, Spain
Univ Autonoma Barcelona, Med, Barcelona, Catalunya, Spain
Simon-Talero, M:
Vall dHebron Hosp Univ, Liver Unit, Barcelona, Spain
Univ Autonoma Barcelona, Vall dHebron Inst Recerca, Dept Med, Liver Unit, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Altamirano, J:
Hosp Quironsalud, Dept Internal Med, Barcelona, Spain
Lucey, M:
Univ Wisconsin, Dept Med, Div Gastroenterol & Hepatol, Sch Med & Publ Hlth, Madison, WI USA
Garcia-Tsao, G:
Yale Univ, Sect Digest Dis, New Haven, CT USA
Dept Vet Affairs Connecticut Healthcare, Connecticut Sect Digest Dis, West Haven, CT USA
Brown, RS:
Weill Cornell Med Coll, Div Gastroenterol & Hepatol, New York City, New York, NY USA
Weill Cornell Med Coll, Div Gastroenterol & Hepatol, New York, NY USA
Schwabe, RF:
Columbia Univ, Dept Med, New York, NY USA
Verna, EC:
Columbia Univ, Ctr Liver Dis & Transplantat, Irving Med Ctr, New York, NY USA
Schnabl, B:
Univ Calif San Diego, Dept Med, La Jolla, CA 92093 USA
Bosques-Padilla, F:
Univ Autonoma Nuevo Leon, Hosp San Jose Tecnol Monterrey, Monterrey, Mexico
Mathurin, P:
Serv Malad Lappareil Digestif & Unite INSERM U995, Lille, France
Caballeria, J:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Clin Barcelona, Liver Unit, Barcelona, Spain
Louvet, A:
Serv Malad Lappareil Digestif & Unite INSERM U995, Lille, France
Shawcross, DL:
Kings Coll London, Sch Immunol & Microbial Sci, Inst Liver Sci, Dept Inflammat Biol, London, England
Abraldes, JG:
Univ Alberta, Div Gastroenterol, Liver Unit, Edmonton, AB, Canada
Genesca, J:
Vall dHebron Hosp Univ, Liver Unit, Barcelona, Spain
Univ Autonoma Barcelona, Vall dHebron Inst Recerca, Dept Med, Liver Unit, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Bataller, R:
Univ Pittsburgh, Med Ctr, Ctr Liver Dis, Pittsburgh Liver Res Ctr,Div Gastroenterol Hepato, Pittsburgh, PA USA
Vargas, V:
Vall dHebron Hosp Univ, Liver Unit, Barcelona, Spain
Univ Autonoma Barcelona, Vall dHebron Inst Recerca, Dept Med, Liver Unit, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
hybrid, All Open Access, Hybrid Gold
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