Abstract
Acute-on-chronic liver failure (ACLF) is an important syndrome of liver failure that has a high risk of short-term mortality in patients with chronic liver disease. The development of ACLF is associated with proinflammatory precipitating events, such as infection, alcoholic hepatitis, and intense systemic inflammation. Recently, the role of the gut microbiome has increasingly emerged in human health and disease. Additionally, the gut microbiome might have a major role in the development of liver disease. In this review, we examine evidence to support the role of gut dysbiosis in cirrhosis and ACLF. Additionally, we explore the mechanism by which the gut microbiome contributes to the development of ACLF, with a focus on alcohol-induced liver disease.
Highlights
Kim, H.S.; Jang, M.-K.; Suk, K.T.; The gut microbiome is a complex ecosystem consisting of more than 100 trillion microorganisms [1]
Ahluwalia et al [62] showed that patients with Hepatic encephalopathy (HE) had more evidence of systemic inflammation, gut dysbiosis, and hyperammonemia compared with healthy subjects and cirrhotic patients without HE
Many studies have noted that systemic inflammation and single or multiple organ failure in patients with Acute-on-chronic liver failure (ACLF) are caused by gut dysbiosis and altered metabolic pathways, as well as by many of the altered metabolites from microbial dysbiosis, there is an urgent need to investigate whether there is a difference in the gut microbiome in cirrhosis with regard to the etiology and whether there is a change in the development pattern of ACLF and the prediction, treatment, and prevention of ACLF using the gut microbiome (Table 2)
Summary
H.S.; Jang, M.-K.; Suk, K.T.; The gut microbiome is a complex ecosystem consisting of more than 100 trillion microorganisms [1]. Acute decompensation of cirrhosis and acute-on-chronic liver failure (ACLF) are two major challenges in patients with CLD. Acute decompensation of cirrhosis is defined as the development of ascites, hepatic encephalopathy, jaundice, and/or gastrointestinal hemorrhage only in cirrhotic patients [24,25]. American Consortium for the Study of End-Stage Liver Disease (NACSELD) define the concept of ACLF only in cirrhotic patients [24,27], whereas the definition of the Asian. In Asia, HBV infection (76%) is a major cause of ACLF [25,28,29], which is associated with the increased development of liver and coagulation failure. Many studies have reported that systemic inflammation from bacterial infection and alcohol directly correlate with the severity of ACLF [29,30,31].
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