Simvastatin Plus Rifaximin in Decompensated Cirrhosis

Inclusion Criteria: * Age ≥ 18 years old. * Cirrhosis defined by standard clinical criteria and ultrasonographic findings and/or histology. Cirrhosis of any etiology may be included. Patients with cirrhosis of autoimmune etiology on treatment with corticosteroids must be on stable corticosteroid dose for ≥3-month period before study inclusion. * Child Pugh B/C patients (from 7 to 12 points). * Women of child-bearing potential must have a negative pregnancy test in urine before the inclusion of the study and agree to use highly effective contraceptive methods (combined oral pill, injectable or implanted contraceptive, intrauterine device / intrauterine hormone-releasing system) during the study. Exclusion Criteria: * Patients on treatment with statins or rifaximin one month before study inclusion. * Patients on the waiting list for liver transplantation. * Patients with acute-on-chronic liver failure according to the criteria published by Moreau et al. * Serum creatinine ≥2 mg/dL. * Serum bilirubin\>5 mg/dL. * INR ≥2.5. * Patients with CK elevation of 50% or more above the upper limit of normal at study inclusion. * Bacterial infection within 15 days before study inclusion. * Gastrointestinal bleeding within 15 days before study inclusion. * Current overt hepatic encephalopathy, defined as grade II-IV hepatic encephalopathy. * HIV infection. * Hepatocellular carcinoma outside Milan criteria, defined as a single nodule ≤5 cm or a maximum of 3 nodules with none \>3 cm. * Patients on antiviral therapy for HCV or those who have received it within the last 6 months. * Patients with previous history of myopathy. * Patients on treatment with potent inhibitors of CYP3A4 enzyme (See section 5.2: Concomitant, nonpermitted and permitted medication) * Patients on treatment with drugs with potential interactions with simvastatin * Patients with a history of significant extrahepatic disease with impaired short-term prognosis, including congestive heart failure New York Heart Association Grade III/IV, COPD GOLD \>2, chronic kidney disease with serum creatinine \>2mg/dL or under renal replacement therapy. * Patients with current extrahepatic malignancies including solid tumours and hematologic disorders. * Patients with previous history or increased risk of intestinal obstruction. * Pregnancy or breastfeeding. * Patients included in other clinical trials in the previous month. * Patients with active alcohol consumption of more than 3 units per day. * Patients with mental incapacity, language barrier, bad social support or any other reason considered by the investigator precluding adequate understanding, cooperation or compliance in the study. * Severe alcoholic hepatitis requiring corticosteroid therapy (Maddrey's Discriminant function ≥ 32 and/or ABIC score \> 6.7). * Refusal to give informed consent. * Patients with contraindications for statins or rifaximin. * Known hypersensitivity to rifaxamin (or rifamycin derivatives) or to simvastatin.