title: Gut Microbiota Alterations can predict Hospitalizations in Cirrhosis Independent of Diabetes Mellitus.
abstract: Diabetes (DM) is prevalent in cirrhosis and may modulate the risk of hospitalization through gut dysbiosis. We aimed to define the role of gut microbiota on 90-day hospitalizations and of concomitant DM on microbiota. Cirrhotic outpatients with/without DM underwent stool and sigmoid mucosal microbial analysis and were followed for 90 days. Microbial composition was compared between those with/without DM, and those who were hospitalized/not. Regression/ROC analyses for hospitalizations were performed using clinical and microbial features. 278 cirrhotics [39% hepatic encephalopathy (HE), 31%DM] underwent stool while 72 underwent mucosal analyses. Ultimately, 94 were hospitalized and they had higher MELD, proton pump inhibitor (PPI) use and HE without difference in DM. Stool/mucosal microbiota were significantly altered in those who were hospitalized (UNIFRAC p < = 1.0e-02). Specifically, lower stool Bacteroidaceae, Clostridiales XIV, Lachnospiraceae, Ruminococcacae and higher Enterococcaceae and Enterobacteriaceae were seen in hospitalized patients. Concomitant DM impacted microbiota UNIFRAC (stool, p = 0.003, mucosa, p = 0.04) with higher stool Bacteroidaceae and lower Ruminococcaeae. Stool Bacteroidaceaeae and Clostridiales XIV predicted 90-day hospitalizations independent of clinical predictors (MELD, HE, PPI). Stool and colonic mucosal microbiome are altered in cirrhotics who get hospitalized with independent prediction using stool Bacteroidaceae and Clostridiales XIV. Concomitant DM distinctly impacts gut microbiota without affecting hospitalizations.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, McGuire VA Hospital, Richmond, USA.
authors.forename: Jasmohan S
authors.initials: JS
authors.lastname: Bajaj
authors.affiliation: Microbiome Analysis Center, George Mason University, Manassas, Virginia, USA.
authors.forename: Naga S
authors.initials: NS
authors.lastname: Betrapally
authors.affiliation: Department of Microbiology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.
authors.forename: Phillip B
authors.initials: PB
authors.lastname: Hylemon
authors.affiliation: Department of Biostatistics, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.
authors.forename: Leroy R
authors.initials: LR
authors.lastname: Thacker
authors.affiliation: Division of Gastroenterology, Hepatology and Nutritiony, George Mason University, Manassas, Virginia, USA.
authors.forename: Kalyani
authors.initials: K
authors.lastname: Daita
authors.affiliation: Division of Gastroenterology, Hepatology and Nutritiony, George Mason University, Manassas, Virginia, USA.
authors.forename: Dae Joong
authors.initials: DJ
authors.lastname: Kang
authors.affiliation: Division of Gastroenterology, Hepatology and Nutritiony, George Mason University, Manassas, Virginia, USA.
authors.forename: Melanie B
authors.initials: MB
authors.lastname: White
authors.affiliation: Division of Gastroenterology, Hepatology and Nutritiony, George Mason University, Manassas, Virginia, USA.
authors.forename: Ariel B
authors.initials: AB
authors.lastname: Unser
authors.affiliation: Division of Gastroenterology, Hepatology and Nutritiony, George Mason University, Manassas, Virginia, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fagan
authors.affiliation: Division of Gastroenterology, Hepatology and Nutritiony, George Mason University, Manassas, Virginia, USA.
authors.forename: Edith A
authors.initials: EA
authors.lastname: Gavis
authors.affiliation: Microbiome Analysis Center, George Mason University, Manassas, Virginia, USA.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Sikaroodi
authors.affiliation: Microbiome Analysis Center, George Mason University, Manassas, Virginia, USA.
authors.forename: Swati
authors.initials: S
authors.lastname: Dalmet
authors.affiliation: Division of Gastroenterology, Hepatology and Nutritiony, George Mason University, Manassas, Virginia, USA.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Heuman
authors.affiliation: Microbiome Analysis Center, George Mason University, Manassas, Virginia, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Gillevet
mesh_terms: D003710:Demography; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D000069196:Gastrointestinal Microbiome; D006760:Hospitalization; D006801:Humans; D007413:Intestinal Mucosa / Q000382:microbiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000382:microbiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D025341:Principal Component Analysis; D016896:Treatment Outcome