- Design
- Multinational prospective cohort with stool metagenomics
- Population
- 679 outpatients with cirrhosis in seven countries
- Primary outcome
- Non-elective hospitalisation within 90 days
- Effect
- Combined model AUC 0.84 vs clinical-only 0.79
A multinational cohort of 679 outpatients with cirrhosis from seven countries had stool metagenomic profiling and was followed for 90 days. A quarter needed unplanned hospital admission.
Those admitted had more advanced cirrhosis and lower microbial diversity, a pattern consistent across countries despite different microbial compositions. After adjustment, 19 species remained associated with admission, including more Enterococcus faecium and fewer commensal species. A model combining clinical and microbiome features predicted admission better (AUC 0.84) than clinical features alone (AUC 0.79).
Stool metagenomics is not a clinical test, and the gain in prediction is modest. The consistent loss of commensal, short-chain fatty acid-producing bacteria in those admitted supports careful antibiotic and proton pump inhibitor stewardship in cirrhosis.
- Treat microbiome profiling in cirrhosis as research, not a test to order.
- Review the indication for long-term proton pump inhibitors in patients with cirrhosis.
- Use antibiotics in cirrhosis for clear indications, such as established prophylaxis.
- Continue to use established severity scores to judge risk of admission.
Why it matters
Consistent microbial loss before admission points to the gut as a modifiable target in cirrhosis.
Don't overread it
This is observational and the model has not been validated as a clinical tool.
The statistics, in plain English
An AUC rising from 0.79 to 0.84 is a real but modest improvement in telling apart who will and will not be admitted.
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