Efficacy of the Combination of Simvastatin Plus Rifaximin in Patients With Decompensated Cirrhosis to Prevent ACLF Development

Inclusion Criteria: * Age ≥ 18 years old * Cirrhosis defined by standard clinical criteria, ultrasonographic findings and/or histology * Child-Pugh patients or Child-Pugh C patients (up to 12 points) * Women of child-bearing potential must have a negative pregnancy test in serum before the inclusion in the study and agree to use highly effective contraceptive methods during the study. Highly effective contraceptive methods will include: intrauterine device, bilateral tubal occlusion, vasectomized partner and sexual abstinence. Exclusion Criteria: * Patients on treatment with statins or rifaximin up to one month before study inclusion. * Patients with contraindications for statins or rifaximin therapy. * Known hypersensitivity to simvastatin or rifaximin (or rifamycin derivatives). * Patients with CK elevation of 50% or more above the upper limit of normal at study inclusion. * Patients on treatment with potent inhibitors of CYP3A4 enzyme * Patients on treatment with drugs with potential interactions with simvastatin * Patients with previous history of myopathy. * Patients with previous history of intestinal obstruction or those who are at increased risk of this complication. * Patients with ACLF according to the criteria published by Moreau et al. * Serum creatinine ≥2 mg/dL (176.8 μmol/L). * Serum bilirubin\>5 mg/dL (85.5 μmol/L). * 12\. INR ≥2.5 * Bacterial infection within 10 days before study inclusion. * Gastrointestinal bleeding within 10 days before study inclusion.…