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The secret to predicting hospitalized cirrhosis patients’ health outcomes could be in their gut

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The microbes that are present in cirrhosis patients’ stool when they are admitted to a hospital can help physicians better predict which patients will need intensive care, or even die, during their stay, according to a recently published study led by a researcher at Virginia Commonwealth University.

Jasmohan Bajaj, Ph.D.
Jasmohan Bajaj, Ph.D.

The study, which published in the journal Clinical Gastroenterology and Hepatology in July, determined that the microorganisms present in cirrhosis patients’ stool when they were admitted to the hospital could indicate which patients were at an increased risk for acute-on-chronic liver failure, failure of other organs and death, independent of other clinical factors. Cirrhosis is a leading cause of increased health expenditures due to hospitalizations and of mortality worldwide, according to the National Institutes of Health.

“Liver cirrhosis patients have changes in their intestinal bacteria that can worsen the disease process,” said the study’s lead author, Jasmohan Bajaj, M.D., who teaches in the VCU School of Medicine’s Department of Internal Medicine and practices at the Hunter Holmes McGuire VA Medical Center.    

Bajaj led the North American Consortium for the Study of End-Stage Liver Disease, which is a multicenter consortium with collaborations from George Mason University and other academic and health sciences centers. The consortium followed 181 liver cirrhosis patients who were recruited from seven hospitals across the U.S. and Canada. The patients’ stool was collected upon admission and analyzed for bacteria that live in the gut. The researchers followed up with the patients during hospitalization and monitored them for 30 days to screen for the development of organ failure, intensive care unit admission, and death.

“We found that, in hospitalized patients with cirrhosis, microbial imbalance of the intestinal microbiota upon hospital admission was associated with an increased risk for negative health outcomes,” Bajaj said.

The research adds a new dimension to the current clinical markers used to predict and treat serious health outcomes such as organ failure and ICU admission in cirrhosis patients. “The gut microbes were different in patients who ended up with negative outcomes,” Bajaj said, adding that he hoped the new research would inform strategies to reduce gut microbial imbalance among cirrhosis patients.

The researchers plan to continue the stool analysis study in larger groups of patients to determine the feasibility of routine microbiota testing among hospitalized cirrhosis patients. They also plan to conduct a larger study of fecal microbiota transplants among patients with advanced cirrhosis, with the ultimate goal of preventing hospitalizations.