Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2020; 26(2): 199-218
Published online Jan 14, 2020. doi: 10.3748/wjg.v26.i2.199
Rifaximin improves survival in cirrhotic patients with refractory ascites: A real-world study
Xin-Yue Lv, Hui-Guo Ding, Jun-Fu Zheng, Chun-Lei Fan, Lei Li
Xin-Yue Lv, Hui-Guo Ding, Jun-Fu Zheng, Chun-Lei Fan, Lei Li, Department of Gastroenterology and Hepatology, Beijing You An Hospital, Capital Medical University, Beijing 100069, China
Author contributions: Li L designed the study and performed scientific edits to the manuscript; Lv XY and Ding HG analysed and interpreted the data, and wrote the manuscript; Zheng JF was responsible for the patient follow-up; Lv XY and Fan CL were responsible for data collection.
Supported by the State Key Projects Specialized on Infectious Diseases, No. 2017ZX10203202-004 and No. 2017ZX10203202003008; the Digestive Medical Coordinated Development Centre of the Beijing Municipal Administration of Hospitals, No. XXZ0303; Beijing High-level Health Technicians, No. 2013-03-073; Beijing Municipal Administration of Hospitals’ Ascent Plan, No. DFL20151602.
Institutional review board statement: The study protocol conformed to the Declaration of Helsinki and was approved by the Biomedical Research Ethics Committee of Peking University First Hospital.
Informed consent statement: All participants provided written informed consent for using samples and materials prior to study enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest. Additionally, they have substantially contributed to this current study and approved the content of the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of item.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lei Li, MD, PhD, Associate Professor, Chief Physician, Department of Gastroenterology and Hepatology, Beijing You An Hospital, Capital Medical University, 8 Xitoutiao, Youanmenwai, Beijing 100069, China. m13699119545@163.com
Received: October 18, 2019
Peer-review started: October 18, 2019
First decision: November 22, 2019
Revised: December 6, 2019
Accepted: December 21, 2019
Article in press: December 21, 2019
Published online: January 14, 2020
Abstract
BACKGROUND

Rifaximin has been shown to reduce the incidence of hepatic encephalopathy and other complications in patients with cirrhosis. However, few studies have investigated the effect of rifaximin in cirrhotic patients with refractory ascites.

AIM

To evaluate the effects of rifaximin in the treatment of refractory ascites and to preliminarily explore its possible mechanism.

METHODS

A total of 75 cirrhotic patients with refractory ascites were enrolled in the study (50 in a rifaximin and 25 in a control group). Patients in the rifaximin group were divided into two subgroups according to the presence of spontaneous bacterial peritonitis and treatment with or without other antibiotics (19 patients treated with rifaximin and 31 patients treated with rifaximin plus intravenous antibiotics). All patients received conventional treatment for refractory ascites, while patients in the rifaximin group received oral rifaximin-α 200 mg four times daily for at least 2 wk. The ascites grade, fasting weight, liver and kidney function, and inflammatory factors in the plasma were evaluated before and after treatment. In addition, the gut microbiota was determined by metagenomics sequencing to analyse the changes in the characteristics of the gut microbiota before and after rifaximin treatment. The patients were followed for 6 mo.

RESULTS

Compared with the control group, the fasting weight of patients significantly decreased and the ascites significantly subsided after treatment with rifaximin (P = 0.011 and 0.009, respectively). The 6-mo survival rate of patients in the rifaximin group was significantly higher than that in the control group (P = 0.048). The concentration of interferon-inducible protein 10 decreased significantly in the rifaximin group compared with that in the control group (P = 0.024). The abundance of Roseburia, Haemophilus, and Prevotella was significantly reduced after rifaximin treatment, while the abundance of Lachnospiraceae_noname, Subdoligranulum, and Dorea decreased and the abundance of Coprobacillus increased after treatment with rifaximin plus intravenous antibiotics. The gene expression of virulence factors was significantly reduced after treatment in both subgroups treated with rifaximin or rifaximin plus intravenous antibiotics.

CONCLUSION

Rifaximin mitigates ascites and improves survival of cirrhotic patients with refractory ascites. A possible mechanism is that rifaximin regulates the structure and function of intestinal bacteria, thus improving the systemic inflammatory state.

Keywords: Rifaximin, Cirrhosis, Refractory ascites, Inflammatory factors, Gut microbiota, Metagenomics sequencing

Core tip: This study showed that the unabsorbed antibiotics, rifaximin, mitigates ascites and improves the survival of cirrhotic patients with refractory ascites and the possible mechanism is that rifaximin regulates the structure and function of intestinal bacteria, thus improving the systemic inflammatory state.