The INFECIR-2 Albumin Prevention Study

NCT ID: NCT02034279

Last Updated: 2017-05-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

136 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-05-31

Study Completion Date

2017-02-10

Brief Summary

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The aim of this study is to evaluate whether albumin administration improves short-term survival in patients with advanced cirrhosis and bacterial infections other than Spontaneous Bacterial Peritonitis (SBP).

Detailed Description

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The aim of this study is to evaluate if IV albumin administration improves short-term survival in patients with advanced cirrhosis (serum creatinine ≥ 1.2 mg/dl, serum sodium ≤ 130 mEq/l -milliequivalents per liter- and/or serum bilirubin ≥4 mg/dl) and bacterial infections other than spontaneous bacterial peritonitis (urinary infection, pneumonia, spontaneous or secondary bacteremia, skin/soft tissue infection, acute cholangitis or suspected bacterial infection).

Primary goals of the study:

• Effect of albumin administration on hospital survival

Secondary goals of the study:

* Effect of albumin administration on 28-day and 90-day survival.
* Effect of albumin administration on the incidence of renal dysfunction, AKI, type-1 and 2 Hepatorenal Syndrome (HRS) during hospitalization.
* Effect of albumin on circulatory function estimated by changes in plasma levels of renin and noradrenaline and in serum levels of lactate among infection diagnosis, day 3 and infection resolution.
* Effect of albumin on serum levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha) and nitric oxide (NOX) and on plasma levels of von Willebrand factor (vWF:Ag) at diagnosis and resolution of infection.
* Effect of albumin on blood leukocyte count and serum C-reactive protein levels (CRP) during infection.
* Effect of albumin on the development of other individual organ failures (renal, liver, cerebral, circulatory, coagulation and respiratory), acute-on-chronic liver failure (ACLF type 1, 2 and 3 according to the Canonic Study), CLIF-SOFA score, CLIF-Consortium score, Child-Pugh score and MELD score during hospitalization.
* Evaluation of predictive factors of HRS and ACLF development in non-SBP infections.
* Samples (blood, plasma, serum and urine) will be obtained and stored for genomic, proteomic and standard biochemical investigations in future ancillary studies related to the aim of the study.

Conditions

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Advanced Chronic Liver Disease Urinary Infection Pneumonia Cholangitis Other Bacterial Diseases

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intravenous infusion of albumin

Treatment arm will receive intravenous albumin on days 1 and 3 plus antibiotics

Group Type EXPERIMENTAL

Albumin

Intervention Type DRUG

Intravenous infusion of 20% albumin

No albumin

Only antibiotics

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Albumin

Intravenous infusion of 20% albumin

Intervention Type DRUG

Other Intervention Names

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Albutein 20 by Grifols

Eligibility Criteria

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Inclusion Criteria

* Cirrhotic patients with age ≥18 years
* Diagnosis of urinary infection, pneumonia, spontaneous or secondary bacteremia, skin/soft tissue infection, acute cholangitis or suspected bacterial infection at hospital admission or during hospitalization
* Patients with uncomplicated urinary infections or suspected bacterial infection will require the presence of signs of systemic inflammation: at least 1 diagnostic criterion of systemic inflammatory response syndrome (SIRS) and serum CRP levels ≥1 mg/dl (10 mg/L). This criterion will not be required for the rest of infections
* Analytical data of renal and/or liver dysfunction (serum creatinine ≥ 1.2 mg/dl, serum sodium ≤ 130 mEq/l, serum bilirubin ≥4 mg/dl). Patients with pneumonia or documented bacteremia (positive blood cultures) will require the presence of at least 1 of these analytical criteria to be included in the study. Patients with urinary infection, skin/soft tissue infection, acute cholangitis or suspected bacterial infection will require 2 or more criteria for inclusion

Exclusion Criteria

* \> 72h after infection diagnosis
* Pregnancy
* Acute or subacute liver failure without underlying cirrhosis
* Septic shock
* Severe acute respiratory distress syndrome (Pa02/Fi02 ≤ 100)
* Active or recent variceal bleeding unless controlled for \> 48h
* Ongoing type-1 HRS (past IAC criterion: serum creatinine ≥ 2.5 mg/dl)
* Type-3 ACLF (defined according to the Canonic Study criteria)
* Hemodialysis or other renal replacement therapy
* Evidence of current malignancy (except for hepatocellular carcinoma within Milan criteria or non-melanocytic skin cancer)
* Moderate or severe chronic heart (NYHA class II, III or IV) or pulmonary disease (GOLD IV)
* Severe psychiatric disorders
* Previous liver transplantation
* HIV infection (except for patients under antiretroviral therapy with undetectable viral load, CD4\>200/mm3 and no history of opportunistic infections diagnostic of AIDS)
* Contraindications to albumin (allergy, signs of pulmonary edema)
* Albumin administration (≥ 80g) in the last 2 days
* Spontaneous bacterial peritonitis coinfection
* Use of any investigational drug within 90 days prior to randomization
* Refusal to participate
* Patients who cannot provide prior informed consent and when there is documented evidence that the patient has no legal surrogate decision maker and it appears unlikely that the patient will regain consciousness or sufficient ability to provide delayed informed consent
* Physician and team not committed to intensive care if needed.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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EASL - CLIF Consortium

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Thierry Gustot

Role: PRINCIPAL_INVESTIGATOR

Erasme University Hospital, Brussels, Belgium

Frederick Nevens

Role: PRINCIPAL_INVESTIGATOR

University Hospitals KU, Leuven, Belgium

Faouzi Saliba

Role: PRINCIPAL_INVESTIGATOR

Hôpital Paul Brousse, Villejuif, France

François Durand

Role: PRINCIPAL_INVESTIGATOR

Hôpital Beaujon, Clichy, France

Matthias Dollinger

Role: PRINCIPAL_INVESTIGATOR

University of Ulm, Heidelberg and Tübingen, Germany

Stefan Zeuzem

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Frankfurt, Germany

Alexander Gerbes

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Munich, Germany

Jonel Trebicka

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Bonn, Germany

Henning Gronbaeck

Role: PRINCIPAL_INVESTIGATOR

Aarhus University Hospital

Fin Stolze Larsen

Role: PRINCIPAL_INVESTIGATOR

Rigshospitalet, University of Copenhagen

John Willy Haukeland

Role: PRINCIPAL_INVESTIGATOR

Oslo University Hospital

Andrea de Gottardi

Role: PRINCIPAL_INVESTIGATOR

Bern University Hospital, Switzerland

Aide McCormick

Role: PRINCIPAL_INVESTIGATOR

University College of Dublin, Ireland

Rajiv Jalan

Role: PRINCIPAL_INVESTIGATOR

University College, London

Marco Domenicali

Role: PRINCIPAL_INVESTIGATOR

Santa Orsola-Malpighi Hospital, Bologna, Italy

Paolo Angeli

Role: PRINCIPAL_INVESTIGATOR

University of Padova, Italy

Carlo Alessandria

Role: PRINCIPAL_INVESTIGATOR

San Giovanni Battista Hospital, University of Turin, Italy

Francesco Salerno

Role: PRINCIPAL_INVESTIGATOR

Policlinico IRCCS San Donato, University of Milan, Italy

Agustin Albillos

Role: PRINCIPAL_INVESTIGATOR

Hospital Ramon y Cajal, Madrid, Spain

Victor Vargas

Role: PRINCIPAL_INVESTIGATOR

Hospital Vall d'Hebron, Barcelona, Spain

Javier Fernandez

Role: PRINCIPAL_INVESTIGATOR

Hospital Clinic, Barcelona, Spain

German Soriano

Role: PRINCIPAL_INVESTIGATOR

Hospital Santa Creu i Sant Pau, Barcelona, Spain

Rafael Bañares

Role: PRINCIPAL_INVESTIGATOR

Hospital Gregorio Marañon, Madrid, Spain

Jose Luis Montero

Role: PRINCIPAL_INVESTIGATOR

Hospital Reina Sofia, Cordoba, Spain

Manuela Merli

Role: PRINCIPAL_INVESTIGATOR

Sapienza University of Rome, Italy

Minneke Coenraad

Role: PRINCIPAL_INVESTIGATOR

Leiden University Medical Center

Rudolf Stauber

Role: PRINCIPAL_INVESTIGATOR

Medical University of Graz

Wolfgang Vogel

Role: PRINCIPAL_INVESTIGATOR

Medical Hospital Innsbrück

Locations

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Hospital Clinic

Barcelona, , Spain

Site Status

Countries

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Spain

References

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Guevara M, Terra C, Nazar A, Sola E, Fernandez J, Pavesi M, Arroyo V, Gines P. Albumin for bacterial infections other than spontaneous bacterial peritonitis in cirrhosis. A randomized, controlled study. J Hepatol. 2012 Oct;57(4):759-65. doi: 10.1016/j.jhep.2012.06.013. Epub 2012 Jun 23.

Reference Type BACKGROUND
PMID: 22732511 (View on PubMed)

Thevenot T, Bureau C, Oberti F, Anty R, Louvet A, Plessier A, Rudler M, Heurgue-Berlot A, Rosa I, Talbodec N, Dao T, Ozenne V, Carbonell N, Causse X, Goria O, Minello A, De Ledinghen V, Amathieu R, Barraud H, Nguyen-Khac E, Becker C, Paupard T, Botta-Fridlung D, Abdelli N, Guillemot F, Monnet E, Di Martino V. Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial. J Hepatol. 2015 Apr;62(4):822-30. doi: 10.1016/j.jhep.2014.11.017. Epub 2014 Nov 21.

Reference Type BACKGROUND
PMID: 25463545 (View on PubMed)

Fernandez J, Angeli P, Trebicka J, Merli M, Gustot T, Alessandria C, Aagaard NK, de Gottardi A, Welzel TM, Gerbes A, Soriano G, Vargas V, Albillos A, Salerno F, Durand F, Banares R, Stauber R, Prado V, Arteaga M, Hernandez-Tejero M, Aziz F, Morando F, Jansen C, Lattanzi B, Moreno C, Campion D, Gronbaek H, Garcia R, Sanchez C, Garcia E, Amoros A, Pavesi M, Claria J, Moreau R, Arroyo V. Efficacy of Albumin Treatment for Patients with Cirrhosis and Infections Unrelated to Spontaneous Bacterial Peritonitis. Clin Gastroenterol Hepatol. 2020 Apr;18(4):963-973.e14. doi: 10.1016/j.cgh.2019.07.055. Epub 2019 Aug 5.

Reference Type DERIVED
PMID: 31394283 (View on PubMed)

Related Links

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Other Identifiers

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2013-002416-27

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

INFECIR 2

Identifier Type: -

Identifier Source: org_study_id

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