Cirrhosis With Spontaneous Bacterial Peritonitis
Conditions
Keywords
Bifidobacterium quadruple live tablets, Cirrhosis with spontaneous bacterial peritonitis
Brief summary
This is a prospective, randomized, double-blind, placebo-controlled multicenter clinical study targeting cirrhosis patients with Spontaneous Bacterial Peritonitis(SBP), aiming to evaluate whether adding Bifidobacterium quadruple probiotics can improve infection control rates and reduce SBP recurrence. Meanwhile, by extending the follow-up period into a real-world clinical observation phase, the study will assess whether Bifidobacterium quadruple probiotics can lower SBP recurrence and extend the lifespan of cirrhosis patients. The primary endpoint of the study is the recurrence rate of SBP during the double-blind treatment period. The study plans to enroll 360 patients.
Interventions
DRUGBifidobacterium quadruple live tablets
Take Bifidobacterium quadruple live tablets orally at 4.5 g per dose, which is 9 tablets at a time, once after breakfast, continuously for 2 weeks. After 2 weeks, continue taking Bifidobacterium quadruple live tablets, but switch to 1.5 g per dose, which is 3 tablets per time, three times a day, after meals, and continue until 24 weeks are completed.After the treatment, there's a 24-week open phase where participants can voluntarily take the tablets (1.5g three times a day).
DRUGBifidobacterium quadruple live bacteria tablets placebo
Take 4.5 g of Bifidobacterium quadruple live bacteria tablets placebo orally each time, which is 9 tablets at once, after breakfast in the morning, for 2 weeks. After 2 weeks, continue taking the Bifidobacterium quadruple live bacteria tablets placebo, but change to 1.5 g each time, which is 3 tablets, 3 times a day, taken after meals, until the end of 24 weeks.After the treatment, there's a 24-week open phase where participants can voluntarily take the tablets (1.5g three times a day).
Sponsors
Peking University First Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-80, any gender * Meets the diagnostic criteria of the Cirrhosis Ascites Diagnosis and Treatment Guidelines (2023 edition), confirmed cirrhosis ascites SBP * At least one week before enrollment, no antibiotics or probiotics treatment * The patient has some organ function and is expected to live more than a year. Platelets ≥50×10⁹/L, hemoglobin ≥90 g/L (patients with anemia need appropriate treatment) ALT和AST\<3×ULN Serum creatinine ≤1.5×ULN and creatinine clearance ≥50 mL/min * Voluntarily sign the informed consent form
Exclusion criteria
* Patients with severe liver damage (total bilirubin levels more than 5 times the upper limit of normal, mainly with elevated direct bilirubin), hepatorenal syndrome, or hepatic encephalopathy * Patients with combined blood and other site (like lungs or urinary system) infections, or those with significant hemodynamic changes, or severe SBP infections * Patients with both intrahepatic and extrahepatic malignant tumors, or those with a history of malignant solid tumors or blood cancers * Patients with gastrointestinal bleeding or intestinal obstruction who need emergency treatment * People who have had serious cardiovascular disease in the past 6 months or currently（ Researchers consider clinically significant myocardial ischemia, myocardial infarction, or unstable angina.Severe arrhythmias that researchers consider clinically significant.Heart failure at NYHA class III-IV.Other acute serious complications that are life-threatening） * People with poorly controlled high blood pressure (defined as having a systolic pressure over 160mmHg or a diastolic pressure over 100mmHg despite treatment) * Poorly controlled diabetes (defined as blood sugar over 16.8 mmol/L during the screening period despite treatment) or hypoglycemia (blood sugar below 2.8 mmol/L during screening) * Select patients who have had esophageal or gastric variceal bleeding within the past 6 months, or those whom the investigator deems at risk of bleeding (if an endoscopy was done within the past 6 months, the results should be collected). * People with a history of immune deficiencies, including being HIV positive, having other acquired or congenital immune deficiencies, having idiopathic IgA deficiency, or who have taken systemic steroids (≥10 mg/day of prednisone equivalent) or immunosuppressive drugs within 14 days before the trial or are expected to need them during the trial. * Diagnosed with chronic obstructive pulmonary disease (COPD) and meets the GOLD 2026 Group E criteria * Patients who are currently receiving antiviral treatment for hepatitis C virus (HCV) or have received it within 12 months before screening. Patients whose antiviral treatment for hepatitis B virus (HBV) has been less than 12 months before screening. * Autoimmune hepatitis patients who received corticosteroid treatment in the past 6 months * People who underwent transjugular intrahepatic portosystemic shunt (TIPS) in the past 6 months * Patients with liver cirrhosis who have non-bacterial peritonitis caused by reasons other than SBP * Patients who are allergic to probiotic ingredients or can't take medicine orally * Patients with psychological or mental disorders who are unable to provide an accurate medical history or cooperate * Pregnant or breastfeeding women * Other researchers think these patients are not suitable
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Spontaneous Bacterial Peritonitis(SBP) recurrence rate | Within 6 months of treatment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| SBP recurrence rate | Within 12 weeks of treatment, within 24 weeks of the open phase | — |
| The number of days from controlling SBP infection to the first recurrence of SBP | Study within one year | — |
| SBP infection control rate (assessing overall effectiveness, remarkable effectiveness, effectiveness, and ineffectiveness). | After 2 weeks of treatment | — |
| Number of days it takes for each SBP symptom (bloating, abdominal pain, abdominal tenderness, fever) to disappear or return to normal. | During the two-week hospital stay | — |
| For patients with positive baseline ascitic fluid cultures, the pathogen clearance rate and the proportion of drug-resistant bacteria | 1 week of treatment, 2 weeks of treatment | — |
| Changes in inflammation markers from baseline | After 2 weeks and 24 weeks of treatment | We collected and checked data on IL-6, IL-10, TNF-a, CRP, PCT, white blood cell count, neutrophil count and percentage, and LPS indicators. |
| Changes in gut barrier function compared to baseline | After 2 weeks and 24 weeks of treatment | We collect blood samples to test DAO activity, D-LA, and zonula occludens-1 (zo-1) |
| Changes in immunological test indicators from baseline | After 2 weeks and 24 weeks of treatment | We check and collect data on peripheral blood CD4+, CD8+, the CD4+/CD8+ T cell ratio, and IgA, IgG, IgM levels. |
| Changes in Child-Pugh score from baseline | 2 weeks of treatment, 24 weeks of treatment, 24 weeks of open phase | — |
| The occurrence rate of complications of cirrhosis (esophageal and gastric variceal bleeding, primary liver cancer, hepatorenal syndrome, hepatopulmonary syndrome, hepatic encephalopathy, portal vein thrombosis). | Within 24 and 48 weeks of treatment | — |
| Incidence of diarrhea | Within 24 weeks of treatment | — |
| Antibiotic usage | Within 24 weeks of treatment | Collect information on the types of antibiotics, dosages, frequency, and timing of use from patients using diary cards. |
| 16s RNA sequencing and metabolomics changes compared to baseline | At 2 weeks and 24 weeks of treatment | Collect stool samples for 16sRNA sequencing and metabolomics |
| Changes in NRS-2002 score from baseline | 2 weeks of treatment, 24 weeks of treatment, 24 weeks of open phase | — |
| Changes in lab indicators from baseline | 2 weeks of treatment, 24 weeks of treatment, 24 weeks of open phase | We focus on changes in ALB, TB, ALT, AST, PLT, PT, and blood ammonia levels from baseline. |
| mortality rate | Within 2 weeks and 24 weeks of treatment, and within 24 weeks of the open phase | — |
| Hospital stay | Within 24 weeks of treatment, within 24 weeks of the open phase | We focus on the time and rate of readmission caused by SBP recurrence. |
Countries
China
Contacts
CONTACTGuiqiang Wang
PRINCIPAL_INVESTIGATORGuiqiang Wang, Ph.D
Peking University First Hospital
Outcome results
None listed