E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients with advanced cirrhosis (serum creatinine ≥ 1.2 mg/dl, serum sodium ≤ 130 mEq/l and/or serum bilirubin ≥4 mg/dl), signs of systemic inflammation and urinary infection, pneumonia, skin/soft tissue infection, acute cholangitis or suspected bacterial infection will be included |
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E.1.1.1 | Medical condition in easily understood language |
Patients with advanced cirrhosis, signs of systemic inflammation and urinary infection, pneumonia, skin/soft tissue infection, acute cholangitis or suspected bacterial infection will be included |
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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 | 17.0 |
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 | 17.0 |
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 | 17.0 |
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 | 17.0 |
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 | 17.0 |
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 | 17.0 |
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 |
The primary goal of the study is to evaluate the effect of albumin administration on short term survival (hospital and 28 day survival) in patients with advanced liver disease, signs of infection other than spontaneous bacterial peritonitis and high risk mortality |
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E.2.2 | Secondary objectives of the trial |
There are several secondary objectives being investigated across both treatment arms as part of this study, these include:
* The effect of albumin administration on 90-day survival * The effect of albumin infusion on the incidence of renal dysfunction during hospitalization * The effect of administration on the incidence of type-1 and type-2 Hepatorenal Syndrome (HRS) during hospitalization * The effect of albumin on circulatory function. This is estimated by looking at changes in plasma levels of renin, noradrenaline and in serum lactate levels during treatment of infection in both treatment arms. (The levels of these substances normally increase if a patients condition worsens.) * The effect of albumin on serum levels of various cytokines and glycoproteins (IL-6, TNF-alpha and NOX and in plasma levels of vWF:Ag) in both treatment arms (vWF= Von Willebrand Factor). The levels of these substances normally increase if a patients condition worsens. * Changes in blood leukocyte |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Age between 18 and 79 years. - Diagnosis of liver cirrhosis established by histology or by the combination of clinical, analytical and ultrasonographic data. - Clinical data of systemic inflammation indicated by the presence of at least 1 diagnostic criterion of SIRS and high serum CRP levels (≥ 2 mg/dL or 20 mg/L). - Diagnosis of urinary infection, pneumonia, 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: more than 10 leukocytes per high-power field in urine or a positive reagent strip; (b) pneumonia: presence of new infiltrates on chest x-ray; (c) skin/soft tissue infection: physical exam findings of swelling, erythema, heat and tenderness in the skin; (d) acute cholangitis: cholestasis, compatible symptoms (right upper quadrant pain and jaundice) and radiological data of biliary obstruction and (e) suspected bacterial infection: signs of infection but no identifiable origin of this infection (polymorphonuclear cells in ascitic and pleural fluid < 250/mm3, normal urine sediment and chest X-ray). - Presence of renal and/or liver dysfunction (serum creatinine ≥1.2 mg/dl, serum bilirubin ≥4 mg/dl or serum sodium ≤ 130 mEq/l). Patients with pneumonia will require the presence of at least 1 of these analytical criteria to be included in the study. Two or more criteria will be required in patients with urinary infection, skin/soft tissue infection, acute cholangitis or suspected bacterial infection. |
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E.4 | Principal exclusion criteria |
- > 48h after the diagnosis of infection. - Pregnancy. - Acute or subacute liver failure without underlying cirrhosis. - Septic shock (mean arterial pressure below 60 mmHg during more than 1 hour despite adequate fluid resuscitation and need of vasopressor drugs). - Acute respiratory distress syndrome [PaO2/Fi02 ≤200 or a pulse oximetric saturation (SpO2) to FiO2 ratio ≤214]. - Gastrointestinal bleeding in the last 5 days. - Biopsy proven severe acute alcoholic hepatitis requiring specific treatment. - Type-1 HRS (IAC criteria: serum creatinine ≥ 2.5 mg/dl). - Type-3 ACLF. - Intrinsic nephropathy (proteinuria, hematuria or abnormal findings on renal ultrasonography) with renal failure (serum creatinine chronically ≥ 1.5 mg/dl). - Renal replacement therapy. - Arterial hypertension (systolic blood pressure > 160 mmHg and/or diastolic blood pressure > 90 mmHg). - 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). - Severe pulmonary disease (GOLD III or IV). - Severe psychiatric disorders. - Any immunosuppressive drug. - HIV infection. - Contraindications to albumin (allergy, signs of pulmonary edema) - Administration of any dose of IV albumin in the last 10 days - Clinical indication for albumin use at inclusion (spontaneous bacterial peritonitis coinfection, large volume paracentesis) - 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. |
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E.5 End points |
E.5.1 | Primary end point(s) |
* To evaluate the effect of albumin administration on hospital and 28-day survival |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At day 3, day of infection resolution (or day 7 and every 7 days) and 28 day |
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E.5.2 | Secondary end point(s) |
* Effect of albumin administration on 90-day survival. * Effect of albumin infusion on the incidence of renal dysfunction, 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 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. |
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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 |
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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 |
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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
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 23 |
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 | No |
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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The end of the trial is defined by LVLS
Premature termination based on: * Post-consent determination of ineligibility based on safety or eligibility criteria * Physician's judgment following an adverse event * Patient's /Personal Consultee's decision * Termination of the trial by a regulatory authority * Any other reason for withdrawal that the trial physician or patient / Personal Consultee feels is in the best interest of the patient |
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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 | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 1 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 1 |