Effect of probiotics on hemodynamic changes and complications associated with cirrhosis: A pilot randomized controlled trial

Roman Maslennikov; Irina Efremova; Vladimir Ivashkin; Maria Zharkova; Elena Poluektova; Elena Shirokova; Konstantin Ivashkin

doi:10.4254/wjh.v14.i8.1667

Effect of probiotics on hemodynamic changes and complications associated with cirrhosis: A pilot randomized controlled trial

World J Hepatol. 2022 Aug 27;14(8):1667-1677. doi: 10.4254/wjh.v14.i8.1667.

Authors

Roman Maslennikov^{1

2

3}, Irina Efremova¹, Vladimir Ivashkin^{1

2}, Maria Zharkova¹, Elena Poluektova^{1

2}, Elena Shirokova¹, Konstantin Ivashkin¹

Affiliations

¹ Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow 119435, Russia.
² The Scientific Community for Human Microbiome Research, Moscow 119435, Russia.
³ Consultative and Diagnostic Center No. 2 of Moscow Health Department , Moscow 107764, Russia. mmmm00@yandex.ru.

Abstract

Background: Bacterial translocation exacerbates the hyperdynamic circulation observed in cirrhosis and contributes to a more severe disease course. Probiotics may reduce bacterial translocation and may therefore be useful to redress the circulatory imbalance.

Aim: To investigate the effect of probiotics on hemodynamic parameters, systemic inflammation, and complications of cirrhosis in this randomized placebo-controlled trial.

Methods: This single-blind randomized placebo-controlled study included 40 patients with Child-Pugh class B and C cirrhosis; 24 patients received probiotics (Saccharomyces boulardii) for 3 mo, and 16 patients received a placebo over the same period. Liver function and the systemic hemodynamic status were evaluated pre- and post-intervention. Echocardiography and simultaneous blood pressure and heart rate monitoring were performed to evaluate systemic hemodynamic indicators. Cardiac output and systemic vascular resistance were calculated.

Results: Following a 3-mo course of probiotics in comparison to the control group, we observed amelioration of hyperdynamic circulation [a decrease in cardiac output (P = 0.026) and an increase in systemic vascular resistance (P = 0.026)] and systemic inflammation [a decrease in serum C-reactive protein levels (P = 0.044)], with improved liver function [an increase in serum albumin (P = 0.001) and a decrease in the value of Child-Pugh score (P = 0.001)] as well as a reduction in the severity of ascites (P = 0.022), hepatic encephalopathy (P = 0.048), and cholestasis [a decrease in serum alkaline phosphatase (P = 0.016) and serum gamma-glutamyl transpeptidase (P = 0.039) activity] and an increase in platelet counts (P < 0.001) and serum sodium level (P = 0.048).

Conclusion: Probiotic administration was associated with amelioration of hyperdynamic circulation and the associated complications of cirrhosis.

Keywords: Gut; Gut-heart axis; Gut-liver axis; Heart; Hemodynamics; Microbiota; Portal hypertension; Saccharomyces boulardii.