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

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.

Presepsin as a biomarker of bacterial translocation and an indicator for the prescription of probiotics in cirrhosis

“…Some patients further participated in a study on the effect of the probiotic ( Saccharomyces boulardii ) on the course of cirrhosis[ 33 ]. We chose this probiotic because it has pleiotropic effects: It reestablishes the gut microbiome after dysbiosis[ 34 ], strengthens the intestinal immune barrier[ 35 ], improves the trophic function of gut microbiota[ 36 ], restores the impaired gut barrier, and protects against bacterial translocation[ 37 ] in experimental models and in patients with gut diseases.…”

“…We additionally enrolled 10 patients for this study after the closure of that study. Details of that study are described in the published article[ 33 ]. Among the patients receiving the probiotic, 13 patients had elevated presepsin levels, and 9 patients had normal levels.…”

“…We also studied how the level of presepsin before the therapy targeted at the gut microbiota affects its effectiveness. We recently published a study showing that a probiotic has a positive effect on the severity of cirrhosis[ 33 ]. In this study, we examined how this effect depended on presepsin levels before the start of the therapy.…”

Application of Compositional Data Analysis to Study the Relationship between Bacterial Diversity in Human Faeces and Sex, Age, and Weight

“…This growing knowledge of microbial contributions to energy metabolism presents new opportunities for weight management [ 27 ]. In a recent study, Maslennikov et al [ 38 ] reported a decrease in the abundance of Coprococcus , Desulfovibrio , and Senegalimassilia in the gut microbiome of patients with body cell mass deficiency. Desulfovibrio has also been negatively correlated with body mass index, waist size, triglyceride and uric acid levels, indicating a potential association with host health [ 39 ].…”

Lactococcus Lactis D4 Starter Fermented Milk’s Effect on Liver Function of Obstructive Jaundice Model

“…In the study of Liu et al (2020), administration of Lactobacillus rhamnosus GG in obstructive jaundice model mice for 11 days led to a significant decrease in SGOT, ALP and direct bilirubin levels, accompanied by a tendency to decrease SGPT and total bilirubin levels. Probiotic administration is also known to improve cholestasis conditions characterized by decreased levels of ALP and GGT in hepatic cirrhosis patients who get Saccharomyces boulardii probiotic therapy for 3 months (Maslennikov et al, 2022). From some of the studies above, it can be seen that the duration of administration and the type and number of lactic acid bacteria given can affect the improvement of ALP and GGT levels in obstructive jaundice conditions.…”