Published online May 27, 2021. doi: 10.4254/wjh.v13.i5.557
Peer-review started: January 16, 2021
First decision: February 24, 2021
Revised: February 28, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: May 27, 2021
Gut dysbiosis is common in cirrhosis.
To study the influence of gut dysbiosis on prognosis in cirrhosis.
The case-control study included 48 in-patients with cirrhosis and 21 healthy controls. Stool microbiome was assessed using 16S ribosomal ribonucleic acid gene sequencing. We used modified dysbiosis ratio (MDR): [Bacilli (%) + Proteobacteria (%)]/[Clostridia (%) + Bacteroidetes (%)]. Patients with MDR more the median made up the group with severe dysbiosis, others did the group with non-severe dysbiosis. The follow-up period was 4 years.
The mortality rate of patients with severe dysbiosis was significantly higher than that of patients with non-severe dysbiosis (54.2% vs 12.5%; P = 0.001). The presence of severe dysbiosis was independent risk factors for death [hazard ratio = 8.6 × (1.9-38.0); P = 0.005]. The abundance of Enterobacteriaceae (P = 0.002), Proteobacteria (P = 0.002), and Lactobacillaceae (P = 0.025) was increased and the abundance of Firmicutes (P = 0.025) and Clostridia (P = 0.045) was decreased in the deceased patients compared with the survivors. The deceased patients had a higher MDR value than the survivors [0.131 × (0.069-0.234) vs 0.034 × (0.009-0.096); P = 0.004]. If we applied an MDR value of 0.14 as the cutoff point, then it predicted patient death within the next year with a sensitivity of 71.4% and a specificity of 82.9% [area under the curve = 0.767 × (0.559-0.974)]. MDR was higher in patients with cirrhosis than in health controls [0.064 × (0.017-0.131) vs 0.005 × (0.002-0.007); P < 0.001], and in patients with decompensated cirrhosis than in patients with compensated cirrhosis [0.106 × (0.023-0.211) vs 0.033 × (0.012-0.074); P = 0.031]. MDR correlated negatively with prothrombin (r = -0.295; P = 0.042), cholinesterase (r = -0.466; P = 0.014) and serum albumin (r = -0.449; P = 0.001) level and positively with Child–Turcotte–Pugh scale value (r = 0.360; P = 0.012).
Gut dysbiosis is associated with a poorer long-term prognosis in cirrhosis.
Core Tip: The mortality rate of patients with severe dysbiosis was significantly higher than that of patients with non-severe dysbiosis. The abundance of Enterobacteriaceae, Proteobacteria, and Lactobacillaceae was increased and the abundance of Firmicutes and Сlostridia was decreased in the deceased patients compared with survivors. The abundance of Bacilli, Enterococcaceae and Lactobacillaceae was higher and the abundance of Clostridia was lower in those who died during the first year of follow-up compared with those who survived this year. The abundance of Enterobacteriaceae and Proteobacteria was higher in those who died in 2nd-4th years of follow-up compared with survivors.