How to predict risk of hospitalisation from chronic liver damage

Turns out, gut microbes could help predict the risk of hospitalisation for patients with chronic liver damage, which can result from a variety of causes and lead to scarring and liver failure. In medical terms, the condition is known as cirrhosis.

According to researchers at Virginia Commonwealth University, the gut microbiome — a collection of bacteria and other microbes in the gut — could be a highly accurate predictor of hospitalisations for patients with cirrhosis. The study determined that analysis of microbial DNA and microbial RNA could be used alongside current clinical methods to more accurately predict 90-day hospitalisations.

Microbial DNA analysis identifies live and dead bacterial species, while microbial RNA analysis identifies the most metabolically active microbial species. Cirrhosis is a leading cause of increased health expenditures due to hospitalisations and of mortality worldwide, according to the National Institute on Alcohol Abuse and Alcoholism, which is part of the National Institutes of Health.

“The hospitalisations that take place with cirrhosis are exorbitantly expensive,” said the paper’s lead author, Jasmohan Bajaj. “Anything that helps us predicts the likelihood of hospitalisation is better than the status quo.” Bajaj and collaborators from George Mason University theorised that relative abundances of pathogenic and non-pathogenic bacteria in the gut microbiome would be accurate predictors of hospitalisation because of their link with inflammation, which often leads to infection.

“One of the major sources of inflammation in patients with cirrhosis or individuals who are obese is pathogenic bacteria, so, we began looking at gut microbes,” Bajaj said. “People with cirrhosis who are hospitalised tend to get an inflammatory surge in their body because of infections and other organ failures.”

The researchers conducted a trial of patients with cirrhosis at VCU Medical Center and McGuire VA Medical Center who were classified according to cirrhosis-related complications, such as renal dysfunction and infection. Both DNA and RNA analysis were found to be equally effective at predicting hospitalisation when combined with the standard predictive blood test.

They also were more effective than the standard predictive blood test score alone. Researchers also found that DNA and RNA analysis identified similar beneficial bacteria but differed in the pathogenic bacteria identified in all patient groups tested.

The team is preparing for a multicentre trial with a consortium of North American research centres that would further confirm the effectiveness of microbial analysis in cirrhosis outcome prediction. The findings are published in the journal JCI Insight.

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