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Dysbiosis in saliva, stool predicts hospitalizations for patients with cirrhosis

Dysbiosis in saliva and stool microbiota was associated with an increased risk of hospitalization due to liver-related conditions in patients with cirrhosis with hepatic encephalopathy, according to published findings.

Researchers, including Jasmohan S. Bajaj, MD, associate professor of gastroenterology, hepatology and nutrition at Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, enrolled patients with cirrhosis (n = 167) and divided them according to hepatic encephalopathy (HE) history. Those who had at least one hospitalization for overt HE within the last year that was currently controlled as an outpatient on lactulose and/or rifaximin (n = 43) were in one group and a compensated age-matched cohort that had no presence of HE were in the other. In addition, age-matched healthy controls without chronic diseases were also recruited and analyzed in the study (n = 32).

Jasmohan S. Bajaj

The researchers conducted a two-part study: a microbiota-inflammatory milieu analysis of the stool, saliva and systemic circulation, and then an evaluation of salivary inflammatory response. They also looked at history of smoking, conducted an oral examination and reviewed dental records within 6 months. Of all the patients with cirrhosis, 102 were included in the final analysis.

The principal component analysis showed stool and saliva microbiome to be clustered far apart, indicating “differences between sites as a whole,” according to the research. In salivary microbiome and among patients with previous HE, “relative abundance of autochthonous families decreased,” whereas pathogenic ones increased in saliva, researchers wrote. The endotoxin-related predictors were significantly higher in the saliva of patients with cirrhosis.

In stool microbiome, relative autochthonous taxa abundance was lower in patients with previous HE, and there was increased Enterobacteriaceae and Enterococcaceae. The stool microbiota of patients with cirrhosis showed a higher correlation with systemic inflammation compared with saliva microbiota.

Of all the patients, 38 were hospitalized within 90 days, with worsening salivary dysbiosis, which was independent of cirrhosis severity, according to the researchers.

“The findings demonstrate that a similar dysbiosis or predominance of unfavorable microbiota exist in the mouth compared to the gut, which could predict hospitalizations in these patients,” Bajaj told Healio.com/Hepatology. “We also found that the salivary inflammatory and defense responses were impaired in cirrhotic patients compared to healthy controls and microbiota in the saliva, and not only the gut, could potentially be a source for endotoxin production.”

An additional 86 age-matched patients (n = 43 with cirrhosis) were evaluated for salivary inflammation. The researchers found significantly higher interleukin (IL)-6/IL-1beta and secretory immunoglobulin A and lower lysozyme and histatins 1 and 5 in the patients with cirrhosis compared with controls, according to the research.

“We believe this paper shows that the mouth can also be an area affected in patients with cirrhosis and should be carefully assessed,” Bajaj said.

The researchers concluded: “The alteration in bacterial composition in saliva is associated with a higher risk of further hospitalization owing to liver-related conditions. This could reflect a global mucosal-immune interface change in patients with cirrhosis and represent a target for future microbiota research into the prognostication of cirrhosis.” – by Melinda Stevens

Disclosures: Bajaj reports no relevant financial disclosures. Please see the study for a full list of all other authors’ relevant financial disclosures.