厚壁菌门/拟杆菌门比值和厚壁菌门/变形菌门比值与拉丁美洲肝硬化患者队列的预后不良相关。

Firmicutes/Bacteroidetes and Firmicutes/Proteobacteria ratios are associated with worse prognosis in a cohort of Latin American patients with cirrhosis.

机构信息

Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Experimental Laboratory of Hepatology and Gastroenterology, Center for Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.

出版信息

Clinics (Sao Paulo). 2024 Aug 3;79:100471. doi: 10.1016/j.clinsp.2024.100471. eCollection 2024.

DOI:10.1016/j.clinsp.2024.100471

PMID:39098143

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11345307/

Abstract

BACKGROUND

Some evidence suggests an association between gut dysbiosis and cirrhosis progression. The authors investigated Gut Microbiome (GM) influence on 90-day mortality and hospitalization/rehospitalization rates in cirrhotic patients.

METHODS

Compensated/decompensated outpatients and decompensated inpatients were prospectively included and compared to healthy controls. Clinical, laboratory, GM, and two ratios between phyla were evaluated. Patients were followed up for 90 days for hospitalization/rehospitalization and mortality.

RESULTS

165 individuals were included (50 compensated, 49 decompensated outpatients; 36 decompensated inpatients; 30 healthy), 48.5 % female, mean age was 61, main cirrhosis etiology was hepatitis C (27.3 %), and mostly Child-Pugh (CP) B patients, median MELD of 13. As liver disease progressed, microbiota diversity decreased between the groups (p = 0.05; p < 0.004). There were 9 deaths and 22 hospitalizations or rehospitalizations. GM composition had correlation with norfloxacin (p = 0.36, p = 0.04), encephalopathy (p = 0.31, p = 0.01), lactulose (p = 0.26, p = 0.01), 90-day mortality (p = 0.22, p = 0.04), CP (p = 0.17, p = 0.01), previous 6-month antibiotic use (p = 0.16, p = 0.01), MELD (p = 0.145, p = 0.01), ALBI (p = 0.1, p = 0.04) and 90-day hospitalization/rehospitalization (p = 0.08, p = 0.03). Firmicutes/Bacteroidetes (F/B) and Firmicutes/Proteobacteria (F/P) ratios were progressively lower and more significant and had an association with 90-day mortality (p < 0.001). Three MELD set-points (≥ 15, 18 and 20) were significantly associated with both ratios, with similar accuracies.

CONCLUSIONS

GM dysbiosis was associated with higher CP, MELD, 90-day mortality and hospitalization/rehospitalization. F/B and F/P ratios were associated with 90-day mortality.

摘要

背景

一些证据表明肠道菌群失调与肝硬化进展有关。作者研究了肠道微生物组（GM）对肝硬化患者 90 天死亡率和住院/再住院率的影响。

方法

前瞻性纳入代偿期/失代偿期门诊患者和失代偿期住院患者，并与健康对照组进行比较。评估临床、实验室、GM 和两个门之间的比例。对患者进行 90 天的住院/再住院和死亡率随访。

结果

共纳入 165 人（50 例代偿期，49 例失代偿期门诊患者；36 例失代偿期住院患者；30 例健康对照），女性占 48.5%，平均年龄 61 岁，主要肝硬化病因是丙型肝炎（27.3%），大多为 Child-Pugh（CP）B 级患者，中位 MELD 为 13。随着肝病的进展，各组之间的微生物多样性逐渐降低（p=0.05；p<0.004）。共有 9 例死亡和 22 例住院或再住院。GM 组成与诺氟沙星（p=0.36，p=0.04）、肝性脑病（p=0.31，p=0.01）、乳果糖（p=0.26，p=0.01）、90 天死亡率（p=0.22，p=0.04）、CP（p=0.17，p=0.01）、6 个月前抗生素使用（p=0.16，p=0.01）、MELD（p=0.145，p=0.01）、ALBI（p=0.1，p=0.04）和 90 天住院/再住院率（p=0.08，p=0.03）相关。厚壁菌门/拟杆菌门（F/B）和厚壁菌门/变形菌门（F/P）比值逐渐降低，且更显著，与 90 天死亡率相关（p<0.001）。三个 MELD 切点（≥15、18 和 20）与这两个比值均显著相关，具有相似的准确性。