Alterations in Gut Microbiome in Cirrhosis as Assessed by Quantitative Metagenomics: Relationship With Acute-on-Chronic Liver Failure and Prognosis

Background and AimsCirrhosis is associated with changes in gut microbiome composition. Although acute-on-chronic liver failure (ACLF) the most severe clinical stage of cirrhosis, there lack information about alterations ACLF using quantitative metagenomics. We investigated patients cirrhosis encompassing whole spectrum disease (compensated, acutely decompensated without ACLF, ACLF). A group healthy subjects was used as control subjects.MethodsStool samples were collected prospectively 182 cirrhosis. DNA library construction sequencing performed Ion Proton Sequencer (ThermoFisher Scientific, Waltham, MA). Microbial genes grouped into clusters, denoted metagenomic species.ResultsCirrhosis a remarkable reduction gene species richness compared subjects. This loss correlated stages particularly marked persisted after adjustment for antibiotic therapy. significant increase Enterococcus Peptostreptococcus sp some autochthonous bacteria. Gut model end-stage Child-Pugh scores organ complications, hepatic encephalopathy infections. Interestingly, predicted 3-month survival good stable predictors. Functional analysis showed that had enriched pathways related to ethanol production, γ-aminobutyric acid metabolism, endotoxin biosynthesis, among others.ConclusionsCirrhosis characterized by parallel maximal ACLF. Altered complications survival. may contribute progression poor prognosis. These results should be confirmed future studies. Cirrhosis Stool species. others.