Among hospitalized patients with cirrhosis, dysbiosis of the intestinal microbiota on admission is associated with increased risk of extra-hepatic organ failure, acute-on-chronic liver failure (ACLF), and death, according to a recent study. Stool samples were collected from 181 patients with cirrhosis (age 56 years) at the time of admission and these patients were followed for 30 days for development of ACLF, extra-hepatic organ failures, and death or hospice care. Researchers found:

• ACLF developed in 8% of study participants; 16% were transferred to intensive care and 21% died.
• Beta diversity of the intestinal microbiome was significantly different, whereas diversity was similar, between those with vs without outcomes.
• The cirrhosis dysbiosis ratio (CDR) was lower in those who developed ACLF.
• Changes in the microbiota associated with extra-hepatic organ failure, transfer to intensive care, ACLF, and death, independent of clinical factors.