Gut dysbiosis is associated with poorer long-term prognosis in cirrhosis

BACKGROUND Gut dysbiosis is common in cirrhosis.AIM To study the influence of gut dysbiosis on prognosis in cirrhosis.METHODS The case-control study included 48 in-patients with cirrhosis and 21 healthy controls.Stool microbiome was assessed using 16S ribosomal ribonucleic acid gene sequencing.We used modified dysbiosis ratio(MDR):[Bacilli(%)+Proteobacteria(%)]/[Clostridia(%)+Bacteroidetes(%)].Patients with MDR more the median made up the group with severe dysbiosis,others did the group with nonsevere dysbiosis.The follow-up period was 4 years.RESULTS The mortality rate of patients with severe dysbiosis was significantly higher than that of patients with non-severe dysbiosis(54.2%vs 12.5%;P=0.001).The presence of severe dysbiosis was independent risk factors for death[hazard ratio=8.6×(1.9-38.0);P=0.005].The abundance of Enterobacteriaceae(P=0.002),Proteobacteria(P=0.002),and Lactobacillaceae(P=0.025)was increased and the abundance of Firmicutes(P=0.025)and Clostridia(P=0.045)was decreased in the deceased patients compared with the survivors.The deceased patients had a higher MDR value than the survivors[0.131×(0.069-0.234)vs 0.034×(0.009-0.096);P=0.004].If we applied an MDR value of 0.14 as the cutoff point,then it predicted patient death within the next year with a sensitivity of 71.4%and a specificity of 82.9%[area under the curve=0.767×(0.559-0.974)].MDR was higher in patients with cirrhosis than in health controls[0.064×(0.017-0.131)vs 0.005×(0.002-0.007);P<0.001],and in patients with decompensated cirrhosis than in patients with compensated cirrhosis[0.106×(0.023-0.211)vs 0.033×(0.012-0.074);P=0.031].MDR correlated negatively with prothrombin(r=-0.295;P=0.042),cholinesterase(r=-0.466;P=0.014)and serum albumin(r=-0.449;P=0.001)level and positively with Child–Turcotte–Pugh scale value(r=0.360;P=0.012).CONCLUSION Gut dysbiosis is associated with a poorer long-term prognosis in cirrhosis.

A Prognostic Model of the Development of Postpartum Purulent-Inflammatory Diseases

Background: Currently, postpartum purulent-inflammatory diseases continue to be a prominent issue in medicine. As a result, numerous scientific publications were devoted to finding the solution to this issue. Primarily these solutions included the idea of optimisation of antibiotic-based disease prevention and therapies. However, the early diagnosis and prognosis of these pathologies were unfortunately overlooked. The Aim of the Study: To build a prognostic model of the development of postpartum purulent-inflammatory diseases. Material and Methods: The main focus of our research was establishment of methods of early diagnosis and prognosis of purulent-inflammatory diseases. The main cohort consisted of 170 women diagnosed with purulent-inflammatory diseases while the control cohort was made of 40 women with an uncomplicated course of pregnancy;patient’s blood serum was analysed using fluorescence spectroscopy. Additionally, we implied a variety of standardised algorithms used during clinical and laboratory examination of the patients with postpartum endometritis. Results: Fluorescence spectra were studied for 40 women of control group and 170 women of the main group. Based on the data obtained using fluorescence spectroscopy and data from clinical and laboratory examinations (extragenital pathology, gynecology-related diseases, risk of miscarriage, surgery, TORCH-infections, colpitis, labour duration > 12 hrs, labour anomalies, maximum blood serum fluorescence spectrum values, fluorescence spectrum ≤ 0.845, age, number of bed days, fetal distress), we have derived a prognostic model of the development of postpartum purulent-inflammatory diseases. Conclusion: As a result, we derived a prognostic model based on the main 13 factors, which contribute to development of postpartum purulent-inflammatory diseases. This model was determined correct with a probability of over 99% (р 2 = 174.74;df = 13).