E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Male and female cirrhotic patients with advanced cirrhosis (serum creatinine ≥ 1.2 mg/dl, serum sodium ≤ 130 mEq/l and/or serum bilirubin ≥4 mg/dl), and 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. |
- Männer und Frauen im Alter = oder > 18 -Leberzirrhose (Laborwerte: Kreatinin ≥ 1,2 mg/dl, Natrium ≤ 130 mmol/l und/oder Bilirubin ≥ 4 mg/dl) -Diagnose eines bakteriellen Infekts (Harnwegsinfekt, Pneumonie, spontane oder sekundäre Bakteriämie, Haut/Weichteilinfekt, akute Cholangitis, Verdacht auf bakterielle Infektion)
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E.1.1.1 | Medical condition in easily understood language |
Patients with advanced cirrhosis ,and urinary infection, pneumonia, spontaneous or secondary bacteremia, skin/soft tissue infection, acute cholangitis or suspected bacterial infection will be included |
Patienten mit fortgeschrittener Leberzirrhose und einer bakteriellen Infektion (nicht SBP) - (Harnwege, Luftwege, spontane/sekundäre Bakteriämie, Haut/Weichteile, akute Cholangitis). |
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E.1.1.2 | Therapeutic area | Diseases [C] - Digestive System Diseases [C06] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10008954 |
E.1.2 | Term | Chronic liver disease and cirrhosis |
E.1.2 | System Organ Class | 10019805 - Hepatobiliary disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10024667 |
E.1.2 | Term | Liver cirrhosis |
E.1.2 | System Organ Class | 10019805 - Hepatobiliary disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10019641 |
E.1.2 | Term | Hepatic cirrhosis |
E.1.2 | System Organ Class | 10019805 - Hepatobiliary disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10064704 |
E.1.2 | Term | Decompensated cirrhosis |
E.1.2 | System Organ Class | 10019805 - Hepatobiliary disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10009213 |
E.1.2 | Term | Cirrhosis of liver |
E.1.2 | System Organ Class | 10019805 - Hepatobiliary disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10009211 |
E.1.2 | Term | Cirrhosis liver |
E.1.2 | System Organ Class | 10019805 - Hepatobiliary disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Effect of albumin administration on in-hospital survival. |
Effekt der Albumingabe auf das Überleben im Krankenhaus |
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E.2.2 | Secondary objectives of the trial |
Effect of albumin administration on •28-day and 90 day survival • incidence of AKI, renal dysfunction, type-1 and 2 HRS during hospitalization • 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 • serum levels of IL-6, tTNF-alpha and nitric oxide (NOX) and on plasma levels of von Willebrand factor (vWF:Ag) at diagnosis and resolution of infection • blood leukocyte count and serum C-reactive protein levels (CRP) during infection • 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 including antibiotic prophylaxis. |
Effekt d. Albumingabe auf - das 28 und 90-Tg-Überleben -die Inzidenz einer Nierenfunktionseinschränkung, des hepatorenalen Syndroms Typ 1 oder 2 -die Kreislauffunktion, gemessen an Renin-, Noradrenalin- und Laktat-Spiegeln im Serum -die Serumspiegel von IL-6, TNF-alpha, NO und von Willebrand Faktor (im Plasma) -auf die Leukozytenzahl und die CRP-Konzentration -Effekt d. Albumingabe auf die Entwicklung von Organversagen, gemessen mit verschiedenen Scores -Bewertung des prädiktiven Faktors eines HRS und ACLF Entwicklung bei nicht-SBP Infektionen einschließlich Antibiotika Prophylaxe. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male and female patients with age ≥ 18 years. 2. Diagnosis of liver cirrhosis established by histology or by the combination of clinical, analytical and ultrasonographic data. 3. 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. Diagnostic criteria at inclusion will be the following: (a) Urinary infections: signs of systemic inflammation (described in criterion number 4) and more than 10 leukocytes per high-power field in urine or a positive reagent strip; (b) Pneumonia: signs of infection (described below) and presence of new infiltrates on chest x-ray; (c) Skin/soft tissue infection: signs of infection and physical exam findings of swelling, erythema, heat and tenderness in the skin; (d) Acute cholangitis: signs of infection and cholestasis, compatible symptoms (right upper quadrant pain and jaundice) and radiological data of biliary obstruction; (e) Spontaneous bacteremia: positive blood cultures and no cause of bacteremia; (f) Secondary bacteremia: positive blood and catheter cultures or bacteremia within 24h after invasive procedure; (g) Suspected bacterial infection: signs of systemic inflammation (described in criterion number 4) but no identifiable origin of this infection (polymorphonuclear cells in ascitic and pleural fluid < 250/mm3, normal urine sediment and chest X-ray). 4. Patients with uncomplicated urinary infections or suspected bacterial infections will require the presence of signs of systemic inflammation: at least 1 diagnostic criterion of systemic inflammatory response syndrome (SIRS) and high serum CRP levels (≥1 mg/dL or 10 mg/L). This criterion will not be required for the rest of infections. 5. Analytical data of renal and/or liver dysfunction (serum creatinine ≥1.2 mg/dl, serum sodium ≤130 mEq/l or 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.
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-Männer und Frauen 18 Jahre und älter -Leberzirrhose -Diagnose eines bakteriellen Infekts (z.B. Harnwegsinfekt, Pneumonie, spontane oder sekundäre Bakteriämie, Haut/Weichteilinfekt, akute Cholangitis, Verdacht auf bakterielle Infektion) entsprechend der Diagnosekriterien -Bei Patienten mit unkomplizierten HWI oder dem Verdacht auf bakterielle Infektion muss mindestens 1 diagnostisches Kriterium einer SIRS vorliegen und erhöhte CRP Werte (≥1 mg/dL or 10 mg/L); dieses Kriterium ist nicht erforderlich bei anderen Infektionen -Vorhandensein einer Nieren- und/oder Leberfunktionsstörung (Laborwerte: (serum creatinine ≥1.2 mg/dl, serum sodium ≤130 mEq/l oder serum bilirubin ≥4 mg/dl); bei Patienten mit Pneumonie oder dokumentierter Bakteriämie (eindeutige Blutkultur) erfordert es die Präsenz eines dieser analytischen Kriterien, um in die Studie eingeschlossen werden zu können; bei Patienten mit HWI, Haut/Weichteilinf., akuter Cholangitis oder Verdacht auf bakterielle Infektion werden 2 oder mehr Kriterien erforderlich. |
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E.4 | Principal exclusion criteria |
1. More than 72h after infection diagnosis. 2. Pre-menopausal women (last menstruation ≤ 12 months prior to enrolment) who are nursing or pregnant or are of child bearing potential and are not practicing an acceptable method of birth control. The methods considered as acceptable are: intrauterine devices, double barrier method (condom or diaphragm with spermicide), hormonal methods (oral contraceptive, contraceptive patch, long-acting injectable contraceptive) and tubal ligation. 3. Acute or sub-acute liver failure without underlying cirrhosis. 4. Septic shock (mean arterial pressure below 60 mmHg during more than 1 hour despite adequate fluid resuscitation and need of vasopressor drugs). 5. Severe acute respiratory distress syndrome [PaO2/Fi02 ≤100 or a pulse oximetric saturation (SpO2) to FiO2 ratio ≤89]. 6. Active or recent variceal bleeding (unless controlled for > 48h). 7. Ongoing type-1 HRS (IAC criteria; serum creatinine ≥ 2.5 mg/dl). 8. Type-3 ACLF (defined according to the Canonic Study criteria). 9. Hemodialysis or other type of renal replacement therapy. 10. Evidence of current malignancy (except for hepatocellular carcinoma within Milan criteria or non-melanocytic skin cancer). 11. Previously known moderate or severe chronic heart failure (NYHA class II, III or IV). 12. Previously known severe chronic pulmonary disease (GOLD IV). 13. Previously known severe psychiatric disorders that prevent the patient from giving informed consent and from making autonomous decisions. 14. Previous liver transplantation. 15. Previously known HIV infection (except for patients under antiretroviral therapy with undetectable viral load, CD4 levels > 200/mm3 and no previous history of opportunistic infections diagnostic of AIDS). 16. Contraindications to albumin (allergy, signs of pulmonary edema). 17. Albumin administration (≥ 80 g) in the last 2 days. 18. Spontaneous bacterial peritonitis co-infection. 19. Usage of any investigational drug within 90 days prior to randomization or the planned use of an investigational drug during the course of the current study. 20. Refusal to participate. 21. 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. 22. Physician and team not committed to intensive care if needed.
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-Diagnose des bakteriellen Infekts ist mehr als 72 Stunden zurückliegend -Pre-menopausale Frauen, die stillen oder schwanger sind oder keine zuverlässige Schwangerschaftsverhütung anwenden. Zu den zuverlässigen Methoden der Empfängnisverhütung gehören: Intrauterinpessar, Doppelte Barriere-Methoden (Kondom oder Diaphragma mit Spermizide), hormonelle Empfängnisverhütung (orale Kontrazeptiva, Verhütungspflaster, lang anhaltende injezierbare Kontrazeptiva), Sterilisation. -(Sub-)Akutes Leberversagen ohne Zirrhose -Septischer Schock -ARDS (acute respiratory distress syndrome);[PaO2/Fi02 ≤100 or a pulse oximetric saturation (SpO2) to FiO2 ratio ≤89] -aktive oder jüngere Varizenblutung (ausgenommen unter Kontrolle > 48h) -Akute alkoholische Hepatitis (durch Biopsie gesichert), die eine spezifische Behandlung erfordert -anhaltendes Hepatorenales Syndrom Typ I (IAC criteria; serum creatinine ≥ 2.5 mg/dl) -ACLF Typ 3 (acute on chronic liver failure); (nach Canonic Study Kriterien definiert) -Hämodialyse oder andere Nierenersatzverfahren -Maligne Grunderkrankung (außer HCC innerhalb Milan Kriterien oder nicht melanozytärer Hautkrebs) -Bekannte moderate oder schwere Herzinsuffizienz ab NYHA II -Bekannte schwere COPD (GOLD IV) -Vorher bekannte schwere psychiatrische Störungen, die den Patienten daran hinter, ihr Einverständnis zu geben und autonome Entscheidungen zu treffen -Vorherige Lebertransplantationen -Bekannte HIV Infektion (Ausnahme: Patienten unter antiretroviraler Therapie mit unauffindbarer Viruslast, CD4 levels > 200/mm3 und keine Vorgeschichte opportunistischer Infektionen AIDS Diagnose -Kontraindikationen gegen Albumin (Allergie, Zeichen eines pulmonalen Ödems) -Albumingabe (≥ 80 g) in den letzten 2 Tagen -SBP Ko-Infektion -Anwendung von Prüfpäparaten innerhalb der letzten 90 Tage vor Randomisierung oder der geplante Gebrauch von Prüfpräparaten während der Durchführung dieser klinischen Prüfung -Ablehnung an der klinischen Prüfung teilzunehmen -Patienten, die vorher keine Einwilligung erteilen können und bei denen es keinen dokumentierten rechtlich stellvertretenden Entscheider gibt und es unwahrscheinlich ist, dass der Patient das Bewußtsein wiedererlangt oder die ausreichende Möglichkeit, nachfolgend die Einwilligung zu erteilen -Ablehnung eventuell erforderlicher intensivmedizinischer Maßnahmen durch die betreuenden Ärzte
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E.5 End points |
E.5.1 | Primary end point(s) |
Hospital survival in both treatment arms |
Überleben im Krankenhaus in beiden Behandlungsarmen
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Day 3, day of infection resolution (or day 7 and every 7 days) |
Tag 3, Tag der Genesung von der Infektion (oder Tag 7 und jeder weitere 7. Tag) |
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E.5.2 | Secondary end point(s) |
-Effect of albumin administration on 28-day-survival -Effect of albumin administration on 90-day survival. -Effect of albumin infusion on the incidence of renal dysfunction, AKI, type-1 and type-2 HRS during hospitalization. -Effect of albumin on circulatory function estimated by changes in plasma levels of renin and noradrenaline and by changes in serum lactate levels among infection diagnosis, day 3 and infection resolution. -Effect of albumin on serum levels of IL-6, TNF-alpha and NOX and on plasma levels of vWF:Ag at infection diagnosis and at infection resolution. -Effect of albumin on blood leukocyte count and serum CPR levels during infection. -Effect of albumin infusion on the development of other individual organ failures (renal, liver, cerebral, circulatory, coagulation and respiratory) during hospitalization. -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 including antibiotic prophylaxis. -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. |
-Effekt der Albuminabgabe auf das 28-Tage-Überleben -Effekt der Albumingabe auf das 90-Tage-Überleben -Effekt der Albumingabe auf die Inzidenz einer Nierenfunktionseinschränkung, AKI, des hepatorenalen Syndroms Typ 1 oder 2 während des Krankenhausaufenthaltes -Effekt der Albumingabe auf die Kreislauffunktion, gemessen an Renin-, Noradrenalin- und Laktat-Spiegeln im Serum -Effekt der Albumingabe auf die Serumspiegel von IL-6, TNF-alpha, NO und von Willebrand Faktor (im Plasma) -Effekt der Albumingabe auf die Leukozytenzahl und die CRP-Konzentration -Effekt der Albumingabe auf die Entwicklung von einzelnen Organversagen, gemessen mit verschiedenen Scores -Auswertund der vorhersehbaren Faktoren einer HRS und ACLF Entwicklung in nicht-SBP Infektionen inklusive Antibiotika Prophylaxe
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Day 3, day of infection resolution (or day 7 and every 7 days) Day 28 and Day 90. A time window of ± 1 day is allowed in visits of days 7, 14, 21, 28 and 90. |
Tag 3, Tag der Genesung von der Infektion (oder Tag 7 und jeder weitere 7. Tag) , Tag 28 und Tag 90. Ein Zeitfenster von ± 1 Tag isf für die Besuche an Tag 7, 14, 21, 28 und 90 erlaubt. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | Yes |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
keine Behandlung mit Albumin (nur Standardtherapie) |
lack of treatment with albumin (only standard therapy) |
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E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 28 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |