Gut microbiota predicts severity and reveals novel metabolic signatures in acute pancreatitis
Open accessAbstract
Objective: Early disease prediction is challenging in acute pancreatitis (AP). Here, we prospectively investigate whether the microbiome predicts severity of AP (Pancreatitis—Microbiome As Predictor of Severity; P-MAPS) early at hospital admission. Design: Buccal and rectal microbial swabs were collected from 424 patients with AP within 72 hours of hospital admission in 15 European centres. All samples were sequenced by full-length 16S rRNA and metagenomic sequencing using Oxford Nanopore Technologies. Primary endpoint was the association of the orointestinal microbiome with the revised Atlanta classification (RAC). Secondary endpoints were mortality, length of hospital stay and severity (organ failure >48 hours and/or occurrence of pancreatic collections requiring intervention) as post hoc analysis. Multivariate analysis was conducted from normalised microbial and corresponding clinical data to build classifiers for predicting severity. For functional profiling, gene set enrichment analysis (GSEA) was performed and normalised enrichment scores calculated. Results: After data processing, 411 buccal and 391 rectal samples were analysed. The intestinal microbiome significantly differed for the RAC (Bray-Curtis, p value=0.009), mortality (Bray-Curtis, p value 0.006), length of hospital stay (Bray-Curtis, p=0.009) and severity (Bray-Curtis, p value=0.008). A classifier for severity with 16 different species and systemic inflammatory response syndrome achieved an area under the receiving operating characteristic (AUROC) of 85%, a positive predictive value of 67% and a negative predictive value of 94% outperforming established severity scores. GSEA revealed functional pathway units suggesting elevated short-chain fatty acid (SCFA) production in severe AP. Conclusions: The orointestinal microbiome predicts clinical hallmark features of AP, and SCFAs may be used for future diagnostic and therapeutic concepts. Trial registration number: NCT04777812 .
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Multiple studies have identified changes in intestinal microbiota among AP patients and animal models.
“Multiple studies have identified changes in intestinal microbiota among AP patients and animal models (Ammer-Herrmenau et al. 2024; Zhu et al. 2019).”
From Odoribacter laneus protects intestinal barrier by bile acid-FXR axis in acute pancreatitis (2026) · cites this paper as Ammer-Herrmenau et al. 2024
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Odoribacter laneus protects intestinal barrier by bile acid-FXR axis in acute pancreatitis
Gu, R., Li, J., Qi, J., Sun, R., Wu, H., & Jin, B. (2026) · AMB Express · doi:10.1186/s13568-026-02071-z · Cited by 2 · see citing works
- Authors
- Ammer-Herrmenau, C., Antweiler, K. L., Asendorf, T., Beyer, G., Buchholz, S. M., Cameron, S., Capurso, G., Damm, M., Dang, L., Frost, F., Gomes, A., Hamm, J., Henker, R., Hoffmeister, A., Meinhardt, C., Nawacki, L., Nunes, V., Panyko, A., Pardo, C., Phillip, V., Pukitis, A., Rasch, S., Riekstina, D., Rinja, E., Ruiz-Rebollo, M. L., Sirtl, S., Weingarten, M., Sandru, V., Woitalla, J., Ellenrieder, V., & Neesse, A.
- Affiliations
- Department of Gastroenterology, gastrointestinal Oncology and Endocrinology, University Medical Centre Goettingen, Goettingen, Germany
- Universitätsmedizin Göttingen (DE)
- Ludwig-Maximilians-Universität München (DE)
- Vita-Salute San Raffaele University (IT)
- University Hospital in Halle (DE)
- Universitätsmedizin Greifswald (DE)
- Department of General Surgery, Hospital Professor Doctor Fernando Fonseca, Amadora, Amadora, Portugal
- University Hospital Leipzig (DE)
- Carl von Ossietzky Universität Oldenburg (DE)
- Collegium Medicum, The Jan Kochanowski University in Kielce, Kielce, Poland
- 4th Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- TUM Klinikum (DE)
- Center of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
- Pauls Stradiņš Clinical University Hospital (LV)
- Carol Davila University of Medicine and Pharmacy (RO)
- Hospital Clínico Universitario de Valladolid (ES)
- Clinical Emergency Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Universitätsmedizin Rostock (DE)
- Corresponding author
- Neesse, Albrecht
- ORCID
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2023-12-21
- Volume
- 73
- Issue
- 3
- Pages
- 485-495
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC10894816
- OpenAlex
- W4390047719
- Cited by
- 67
- References
- 53
- Citations by year
- 2026: 33 · 2025: 19 · 2024: 15
- FWCI
- 17.95
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Gut (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Qucosa (Saxon State and University Library Dresden) (submittedVersion, cc-by-nc)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by-nc)
- Funders
- University Medical Centre Goettingen (Start-up funding)
- Topics
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- acute pancreatitis, gut microbiota, disease severity prediction, Revised Atlanta Classification, rectal microbiome, mortality, length of hospital stay, short-chain fatty acids, systemic inflammatory response syndrome, metabolic signatures, prognostic factors
- MeSH terms
- Gastrointestinal Microbiome, Acute Disease, Humans, Pancreatitis, RNA, Ribosomal, 16S, Severity of Illness Index
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