Chronic opioid use is associated with altered gut microbiota and predicts readmissions in patients with cirrhosis
Abstract
BACKGROUND: Opioid use is epidemic in cirrhosis, which could precipitate hepatic encephalopathy (HE) potentially through gut dysbiosis and inflammation. AIM: To define the effect of opioids on readmissions and on gut microbiota composition and functionality. METHODS: Cohort 1 had 200 cirrhotic in-patients (with/without opioid use) followed prospectively through the index hospitalisation and 6 months post discharge. Readmissions (HE-related/unrelated) were compared between patients discharged on opioids compared to the rest, including using a multi-variable analysis. Cohort 2 consisted of 72 cirrhotics on chronic opioids who were age/model for end-stage liver disease (MELD) and prior HE-balanced with 72 cirrhotics not on opioids. Stool microbiota composition (multi-tagged sequencing), predicted functionality (PiCRUST), endotoxemia and systemic inflammation (IL-6, IL-17) were compared. RESULTS: Cohort 1: Chronic opioid use was statistically similar between those admitted with/without HE, and was judged to be an HE precipitant in <5% of cases during the index hospitalisation. Of the 144 patients alive at 6 months, 82 were readmitted. The opioid users had a significantly higher all cause (69% vs. 48%, P = 0.008), but not HE-related readmissions (30% vs. 41%, P = 0.30). On regression, opioid therapy and female gender were predictive of readmission independent of MELD score and previous HE. Cohort 2: Significant dysbiosis was noted in the opioid cohort, especially in HE+opioid patients with lower autochthonous taxa and Bacteroidaceae relative abundance. PiCRUST showed highest aromatic amino acid and endotoxin production in opioid users. Opioid users also had higher endotoxemia and IL-6 but not IL-17. CONCLUSION: Chronic opioid use in cirrhosis is associated with increased endotoxemia, dysbiosis and all-cause readmissions.
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Chronic opioid use in cirrhosis has been associated with increased endotoxemia, gut dysbiosis, inflammation, and all-cause hospital readmission.
“Chronic opioid use in cirrhosis has been associated with increased endotoxemia, gut dysbiosis, inflammation, and all-cause hospital readmission (178).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [178]
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- Authors
- Acharya, C., Betrapally, N. S., Gillevet, P. M., Sterling, R. K., Akbarali, H., White, M. B., Ganapathy, D., Fagan, A., Sikaroodi, M., & Bajaj, J. S.
- Affiliations
- Hunter Holmes McGuire VA Medical Center (US)
- George Mason University (US)
- Corresponding author
- Bajaj, J. S.
- ORCID
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2016-11-20
- Volume
- 45
- Issue
- 2
- Pages
- 319-331
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2552593014
- Cited by
- 175
- References
- 27
- Citations by year
- 2026: 10 · 2025: 17 · 2024: 20 · 2023: 21 · 2022: 23 · 2021: 22 · 2020: 27 · 2019: 18 · 2018: 9 · 2017: 8
- FWCI
- 8.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (CX10076)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- chronic opioid use, liver cirrhosis, gut microbiota, dysbiosis, hepatic encephalopathy, hospital readmission, endotoxemia, systemic inflammation, Bacteroidaceae, aromatic amino acid metabolism, MELD score, female sex as risk factor
- MeSH terms
- Gastrointestinal Microbiome, Analgesics, Opioid, Feces, Female, Hepatic Encephalopathy, Humans, Liver Cirrhosis, Male, Middle Aged, Patient Discharge, Patient Readmission, Endotoxemia, Dysbiosis
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