Rifaximin improves survival in cirrhotic patients with refractory ascites: A real-world study

doi:10.3748/wjg.v26.i2.199

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Jan 14, 2020 (publication date) through Mar 2, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Jan 14, 2020; 26(2): 199-218
Published online Jan 14, 2020. doi: 10.3748/wjg.v26.i2.199

Table 1 Baseline characteristics of patients, n (%)

Characteristic	Rifaximin group (n = 50)	Control group (n = 25)	P value
Age	54.60 ± 9.05	59.04 ± 10.01	0.057
Sex (male/female)	42/8	18/7	0.221
Etiology
HBV	14 (28)	9 (36)	0.479
HCV	3 (6)	0 (0)	0.546
Alcohol	22 (44)	7 (28)	0.180
HBV/alcohol	7 (14)	3 (12)	1.000
NASH	1 (2)	3 (12)	0.105
AIH	1 (2)	0 (0)	1.000
PBC	0 (0)	1 (4)	0.333
Cryptogenic	2 (4)	2 (8)	0.597
Child-Pugh grade (B/C)	21/29	16/9	0.072
MELD score	10 (6-13)	8 (6-10)	0.094
Furosemide (mg/d)	80 (40-80)	80 (40-80)	0.246
Spironolactone (mg/d)	160 (80-160)	160 (100-160)	0.315
Ascites (grade 1/2)	38/12	20/5	0.978
AKI	3 (6)	2 (8)	1.000
SBP	19 (38)	9 (36)	0.866
Hypertension	7 (14)	5 (20)	0.738
Diabetes mellitus	19 (38)	9 (36)	0.866
Biochemistry
ALT (U/L)	24.85 (13.75-42.58)	20.50 (16.40-34.95)	0.673
Alb (g/L)	28.40 ± 5.30	27.68 ± 3.79	0.526
TBil (μmol/L)	43.80 (25.88-93.78)	24.70 (18.75-55.55)	0.039
Scr (μmol/L)	70.20 (57.00-93.53)	64.20 (53.10-74.35)	0.256
Urea (mmol/L)	7.17 ± 4.70	6.68 ± 3.32	0.641
eGFR (mL/min 1.73 m²)	95.49 (76.17-114.81)	98.80 (86.80-109.37)	0.897
Coagulation
PTA (%)	54.00 (45.00-68.50)	64.00 (56.50-74.50)	0.030
INR	1.53 ± 0.39	1.37 ± 0.26	0.074
Routine blood test
WBC (10⁹/L)	4.38 (3.41-6.04)	3.87 (3.26-6.78)	0.955
HGB (g/L)	101.22 ± 25.91	98.36 ± 23.03	0.642
PLT (10⁹/L)	77 (54-102)	101 (56-172)	0.069

Values are given as the mean ± SD if they follow a normal distribution, otherwise given as medians (interquartile range). HBV: Hepatitis B virus; HCV: Hepatitis C virus; NASH: Nonalcoholic steatohepatitis; AIH: Autoimmune hepatitis; PBC: Primary biliary cirrhosis; AKI: Acute kidney injury; SBP: Spontaneous bacterial peritonitis; eGFR: Estimate glomerular filtration rate; PTA: Prothrombin activity; MELD: Model for end-stage liver disease.

Table 2 Changes in clinical data of patients after treatment in the two groups

	Rifaximin group (n = 50)			Control group (n = 25)			P value
	d0	d15	mean delta	d0	d15	Mean delta
Weight (kg)	70.00 (60.00-78.75)	69.00 (58.00-74.00)	-3.30	62.00 (55.00-71.25)	59.5 (54.88-59.5)	-1.20	0.011
Cr (μmol/L)	70.20 (57.00-93.53)	78.25 (63.10-92.68)	11.82	9 (8.00-11.00)	73.0 (63.35-95.65)	13.54	0.777
Urea (mmol/L)	7.17±4.70	9.07±6.71	1.90	8 (5.50-10.00)	7.63±3.31	0.95	0.258
eGFR (mL/min 1.73 m²)	95.49 (76.17-114.81)	93.11 (71.92-108.00)	-5.20	98.80 (86.80-109.37)	92.0 (61.59-99.54)	-9.68	0.136
Child-Pugh score	10 (8.00-11.25)	9 (8.00-10.25)	-0.90	9 (8.00-11.00)	8 (7.50-10.50)	-0.76	0.666
MELD score	10 (6.00-13.00)	11.5 (6.75-15.25)	0.60	8 (5.50-10.00)	8 (6.50-10.00)	0.92	0.688

Delta was defined as the value after treatment minus the value before treatment. eGFR: Estimate glomerular filtration rate; MELD: Model for end-stage liver disease.

Table 3 Changes in the cytokine and lipopolysaccharide-binding protein levels in patients after treatment in the two groups

	Rifaximin group (n = 26)		Control group (n = 13)		P value
	d0	d15	d0	d15	P value
IL-6 (pg/mL)	29.73 ± 101.82	8. 93 ± 6.13	27.05 ± 45.70	18.75 ± 39.11	0.644
IL-8 (pg/mL)	45.12 ± 91.71	117.47 ± 359.77	31.51 ± 90.82	42.92 ± 128.15	0.557
TNF-α (pg/mL)	3.62 ± 2.22	3.23 ± 1.31	2.79 ± 0.72	3.07 ± 0.83	0.356
MCP-1 (pg/mL)	93.32 ± 49.00	98.41 ± 61.21	86.71 ± 44.14	79.61 ± 39.87	0.481
IP-10 (pg/mL)	187.83 ± 180.08	150.35 ± 126.22	98.53 ± 57.02	228.25 ± 232.65	0.024
LBP (pg/mL)	6140682.77 ± 3478004.74	5828915.42 ± 3761441.65	5784964.46 ± 2841716.75	9792449.77 ± 8492517.57	0.071

The data are given as the mean ± SD. Interleukin-6, interleukin-8, tumour necrosis factor alpha, and monocyte chemoattractant protein-1 suggest an inflammatory response; interferon-inducible protein 10 activates inflammatory cells and probably affects hepatic stellate cells and cirrhosis; and lipopolysaccharide-binding protein reflects the degree of the inflammatory response caused by endotoxin. IL-6: Interleukin-6; IL-8: Interleukin-8; TNF-α: Tumour necrosis factor alpha; MCP-1: Monocyte chemoattractant protein-1; LBP: Lipopolysaccharide-binding protein. IP-10: Interferon-inducible protein 10.

Table 4 Changes in the abundance of beneficial bacteria after treatment

Classification	Rifaximin			Rifaximin + antibiotics
Classification	Before	After	P value	Before	After	P value
g_Lactobacillus	1.924	3.903	0.791	0.581	2.535	0.547
g_Bifidobacterium	12.567	21.949	0.301	5.036	9.524	0.641
s_Faecalibacterium_prausnitzii	10.448	8.193	0.910	6.590	3.206	0.148

Citation: Lv XY, Ding HG, Zheng JF, Fan CL, Li L. Rifaximin improves survival in cirrhotic patients with refractory ascites: A real-world study. World J Gastroenterol 2020; 26(2): 199-218
URL: https://www.wjgnet.com/1007-9327/full/v26/i2/199.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i2.199