Gut Microbiome in Cirrhosis Linked to Acute-on-Chronic Liver Failure

gut microbiome
gut microbiome
Researchers analyzed the relationship between an altered gut microbiome and complications of cirrhosis and survival and sought to determine its effect on disease progression and prognosis.

An altered gut microbiome is associated with complications of cirrhosis and survival and may contribute to disease progression and poor prognosis, according to study results published in Gastroenterology.

Cirrhosis of the liver is associated with changes in gut microbiome composition that are believed to play a role in some complications of the disease. Acute-on-chronic liver failure (ACLF) is the most severe clinical stage of cirrhosis; however, there is a lack of information about gut microbiome alterations in ACLF using quantitative metagenomics. Thus, researchers investigated the gut microbiome in 182 patients with cirrhosis, encompassing the whole spectrum of disease (compensated, acutely decompensated without ACLF, and ACLF), and compared them with those of healthy control participants. They found that the existence of marked alterations in the gut microbiome in cirrhosis paralleled the disease stages, already obvious in compensated cirrhosis, progressing in decompensated cirrhosis, and striking in ACLF. The alterations of the gut microbiome consisted of marked reduction in gene and metagenomic richness and progressive enrichment by unusual gut bacteria, particularly the Enterococcus species, with some of them from the oral flora. The alteration of the gut microbiome was associated with disease complications and impaired prognosis. Of note, the gut microbiome predicted 3-month survival, with good stable predictors.

“In conclusion, the results of the current study indicate that human cirrhosis is characterized by remarkable abnormalities in gut microbiome composition with profound reduction in gene and metagenomic richness and marked changes in microbiota composition, with enrichment by unusual gut species; changes being maximal in patients with ACLF compared to compensated cirrhosis and decompensated cirrhosis without ACLF,” the study authors stated.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Solé C, Guilly S, Da Silva K, et al. Alterations in gut microbiome in cirrhosis as assessed by quantitative metagenomics. Relationship with acute-on-chronic liver failure and prognosis ]. Gastroenterology. Published online August 31, 2020. doi: 10.1053/j.gastro.2020.08.054