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Predicting Clinical Outcomes of Cirrhosis Patients With Hepatic Encephalopathy From the Fecal Microbiome
Open accessAbstract
BACKGROUND & AIMS: Gut dysbiosis plays a role in hepatic encephalopathy (HE), while its relationship at the acute episode of overt HE (AHE), the disease progression and clinical outcomes remains unclear. We aimed to identify AHE-specific microbiome and its association to patients' outcomes. METHODS: We profiled fecal microbiome changes for a cohort of 62 patients with cirrhosis and AHE i) before treatment, ii) 2-3 days after medication and iii) 2-3 months after recovery, and three control cohorts i) healthy individuals, patients with ii) compensated or iii) decompensated cirrhosis. RESULTS: Comparison of the microbiome shift from compensated, decompensated cirrhosis, AHE to recovery revealed the AHE-specific gut-dysbiosis. The gut microbiome diversity was decreased during AHE, further reduced after medication, and only partially reversed during the recovery. The relative abundance of Bacteroidetes phylum in the microbiome decreased, whereas that of Firmicute, Proteobacteria and Actinobacteria increased in patients during AHE compared with those with compensated cirrhosis. A total of 70 operational taxonomic units (OTUs) were significantly different between AHE and decompensated cirrhosis abundances. Of them, the abundance of Veillonella parvula increased the most during AHE via a metagenomics recovery of the genomes. Moreover, the relative abundances of three (Alistipes, Bacteroides, Phascolarctobacterium) and five OTUs (Clostridium-XI, Bacteroides, Bacteroides, Lactobacillus, Clostridium-sedis) at AHE were respectively associated with HE recurrence and overall survival during the subsequent one-year follow-up. CONCLUSIONS: AHE-specific gut OTUs were identified that may be involved in HE development and able to predict clinical outcomes, providing new strategies for the prevention and treatment of HE recurrence in patients with cirrhosis.
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“Research has also shown a significant increase in Alcaligenaceae, Porphyromonadaceae, Veillonellaceae, Enterococcus, Megasphaera, and Burkholderia in the GI microbiome of cirrhotic patients with hepatic encephalopathy (HE), and this taxonomic shift has been associated with hyperammonemia and systemic inflammation [164].”
From The Potential Impact of Probiotics on Human Health: An Update on Their Health-Promoting Properties (2024) · cites this paper as [164]
In the citing paper
“Interestingly, research has shown a significant increase in Alcaligenaceae, Porphyromonadaceae, Veillonellaceae, Enterococcus, Megasphaera, and Burkholderia in the GI microbiomes of cirrhotic patients with HE. This taxonomic shift was associated with hyperammonaemia and systemic inflammation contributing to the exacerbation of HE symptoms (Sung et al., 2019).”
From Viral Infections, the Microbiome, and Probiotics (2021) · cites this paper as Sung et al., 2019
In the citing paper
“For example, it is well established that the cognitive impairment arising due to hepatic encephalopathy is mediated by microbial disturbances and can be reversed with oral antibiotic treatment (414–417).”
From Signalling cognition: The gut microbiota and hypothalamic-pituitary-adrenal axis (2023) · cites this paper as [416]
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Metadata
- Authors
- Sung, C. M., Lin, Y.-F., Chen, K.-F., Ke, H.-M., Huang, H.-Y., Gong, Y.-N., Tsai, W.-S., You, J.-F., Lu, M. J., Cheng, H.-T., Lin, C.-Y., Kuo, C.-J., Tsai, I. J., & Hsieh, S.-Y.
- Affiliations
- Chang Gung University (TW)
- Biodiversity Research Center, Academia Sinica (TW)
- Chang Gung Memorial Hospital (TW)
- Corresponding author
- Tsai, Isheng J.
- Hsieh, Sen-Yung
- ORCID
- Venue
- Cellular and Molecular Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2019
- Volume
- 8
- Issue
- 2
- Pages
- 301-318.e2
- ISSN
- 2352-345X (ISSN-L)
- PMC
- PMC6718362
- OpenAlex
- W2938740358
- Cited by
- 127
- References
- 45
- Citations by year
- 2026: 9 · 2025: 16 · 2024: 17 · 2023: 22 · 2022: 24 · 2021: 21 · 2020: 13 · 2019: 5
- FWCI
- 5.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Cellular and Molecular Gastroenterology and Hepatology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Health Research Institutes (NHRI-EX106-10619SC)
- Chang Gung Medical Foundation (CMRPG 3E1411-3, 3H1031-3)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
- Keywords
- hepatic encephalopathy, liver cirrhosis, gut microbiota, gut dysbiosis, fecal microbiota, decompensated cirrhosis, clinical outcome prediction, Veillonella parvula, Bacteroides, Phascolarctobacterium, Clostridium, Lactobacillus, overall survival, microbiome diversity
- MeSH terms
- Gastrointestinal Microbiome, Adult, Aged, Bacteria, Feces, Female, Hepatic Encephalopathy, Humans, Liver Cirrhosis, Male, Middle Aged, Prognosis, Dysbiosis
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