Effect of Vivomixx® on Neuroinflammation in Patients Withs Cirrhosis

Study variables Main variables * Neuroinflammation * Systemic inflammatory response Secondary variables * Cognitive function * Bacterial translocation * Intestinal barrier * Systemic oxidative damage * Time until SBP or other bacterial infection resolution in patients with infections * Incidence of complications of cirrhosis and mortality during the study 40 patients, 20 and 30 in each of the two substudies, respectively Diagnosis and Main Inclusion Criteria * Decompensated patients with cirrhosis: 1. Outpatients with refractory ascites (substudy 1) (n=20) 2. Patients hospitalized because bacterial infection (substudy 2) (n=30) Study Product: Vivomixx®sachets containing 450 x 109 bacteria, 2 every 12 hours (n=25), or placebo (n=25) Duration of administration: 30 days Follow up The following patients' assessments will be performed: in substudy 1 at baseline and at the end of the treatment (30 days), and in substudy 2 at baseline, on day 1, day 2, day 3, day 7, at infection resolution, and at discharge or day 30. Clinical and analytical assessments will be performed every three months after the end of the study Comparator Placebo (we evaluate the probiotic Vivomixx® vs placebo as adjunctive in addition to the standard of care) Statistical Methodology Fisher's exact test for categorical variables and Student's "t" test and Mann-Whitney and Wilcoxon tests for quantitative variables. Correlations will be assessed by Spearman test. A two-sided p value \<0.05 will be considered statistically significant