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The INFECIR-2 Albumin Prevention Study (INFECIR2)

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ClinicalTrials.gov Identifier: NCT02034279
Recruitment Status : Terminated (Low recruitment rate and expiration of the study drug)
First Posted : January 13, 2014
Last Update Posted : May 18, 2017
Sponsor:
Information provided by (Responsible Party):
EASL - CLIF Consortium

Study Description
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Brief Summary:
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).

Condition or disease Intervention/treatment Phase
Advanced Chronic Liver Disease Urinary Infection Pneumonia Cholangitis Other Bacterial Diseases Drug: Albumin Phase 4

Detailed Description:

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.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 136 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Albumin Administration in the Prevention of Hepatorenal Syndrome and Death in Patients With Cirrhosis, Bacterial Infections Other Than Spontaneous Bacterial Peritonitis and High Risk of Hospital Mortality
Actual Study Start Date : May 2014
Actual Primary Completion Date : December 31, 2016
Actual Study Completion Date : February 10, 2017

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Intravenous infusion of albumin
Treatment arm will receive intravenous albumin on days 1 and 3 plus antibiotics
 Drug: Albumin
Intravenous infusion of 20% albumin
Other Name: Albutein 20 by Grifols
No Intervention: No albumin
Only antibiotics


Outcome Measures
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Primary Outcome Measures :
  1. survival [ Time Frame: hospitalization ]
    Hospital survival will be the primary outcome


Secondary Outcome Measures :
  1. survival [ Time Frame: 28-d and 90-day survival ]
    Percentage of subjects within each arm that survived at these time points

  2. Renal dysfunction [ Time Frame: hospitalization (expected average 2 weeks) ]
    number of participants

  3. circulatory dysfunction [ Time Frame: day 3 and day of infection resolution ]
    plasma concentration of hormones

  4. Inflammation and endothelial function [ Time Frame: day of infection resolution ]
    Plasma concentration of cytokines

  5. subsequent organ failure [ Time Frame: hospitalization (expected average 2 weeks) ]
    number of organ failures


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

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.
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02034279


Locations
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Spain
Hospital Clinic
Barcelona, Spain, 08036
Sponsors and Collaborators
EASL - CLIF Consortium
Investigators
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Principal Investigator: Thierry Gustot Erasme University Hospital, Brussels, Belgium
Principal Investigator: Frederick Nevens University Hospitals KU, Leuven, Belgium
Principal Investigator: Faouzi Saliba Hôpital Paul Brousse, Villejuif, France
Principal Investigator: François Durand Hôpital Beaujon, Clichy, France
Principal Investigator: Matthias Dollinger University of Ulm, Heidelberg and Tübingen, Germany
Principal Investigator: Stefan Zeuzem University Hospital of Frankfurt, Germany
Principal Investigator: Alexander Gerbes University Hospital of Munich, Germany
Principal Investigator: Jonel Trebicka University Hospital of Bonn, Germany
Principal Investigator: Henning Gronbaeck Aarhus University Hospital, Aarhus, Denmark
Principal Investigator: Fin Stolze Larsen Rigshospitalet, University of Copenhagen
Principal Investigator: John Willy Haukeland Oslo University Hospital
Principal Investigator: Andrea de Gottardi Bern University Hospital, Switzerland
Principal Investigator: Aide McCormick University College of Dublin, Ireland
Principal Investigator: Rajiv Jalan University College, London
Principal Investigator: Marco Domenicali Santa Orsola-Malpighi Hospital, Bologna, Italy
Principal Investigator: Paolo Angeli University of Padova, Italy
Principal Investigator: Carlo Alessandria San Giovanni Battista Hospital, University of Turin, Italy
Principal Investigator: Francesco Salerno Policlinico IRCCS San Donato, University of Milan, Italy
Principal Investigator: Agustin Albillos Hospital Ramon y Cajal, Madrid, Spain
Principal Investigator: Victor Vargas Hospital Vall d'Hebron, Barcelona, Spain
Principal Investigator: Javier Fernandez Hospital Clinic, Barcelona, Spain
Principal Investigator: German Soriano Hospital Santa Creu i Sant Pau, Barcelona, Spain
Principal Investigator: Rafael Bañares Hospital Gregorio Marañon, Madrid, Spain
Principal Investigator: Jose Luis Montero Hospital Reina Sofia, Cordoba, Spain
Principal Investigator: Manuela Merli Sapienza University of Rome, Italy
Principal Investigator: Minneke Coenraad Leiden University Medical Center
Principal Investigator: Rudolf Stauber Medical University of Graz
Principal Investigator: Wolfgang Vogel Medical Hospital Innsbrück
More Information
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Additional Information:

Publications:

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: EASL - CLIF Consortium
ClinicalTrials.gov Identifier: NCT02034279    
Other Study ID Numbers: INFECIR 2
2013-002416-27 ( EudraCT Number )
First Posted: January 13, 2014    Key Record Dates
Last Update Posted: May 18, 2017
Last Verified: May 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Plan Description: Undecided yet
Keywords provided by EASL - CLIF Consortium:
cirrhosis
Additional relevant MeSH terms:
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Infection
Urinary Tract Infections
Bacterial Infections
Liver Diseases
Cholangitis
Pneumonia
Lung Diseases
 Respiratory Tract Diseases
Respiratory Tract Infections
Digestive System Diseases
Bile Duct Diseases
Biliary Tract Diseases
Urologic Diseases