Cirrhosis, Liver Clinical Trial
Official title:
Microbiome Translocation in Different Circulatory Compartments in Decompensated Cirrhosis
Acquired dysfunctional immunity in cirrhosis predisposes patients to frequent bacterial
infections contributing to disease progression and may lead to the development of
acute-on-chronic liver failure (ACLF). Spontaneous bacterial peritonitis (SBP) is one of the
most frequent infections in cirrhosis and therefore a trigger for ACLF. ACLF is characterized
by systemic inflammation even in the absence of confirmed infection and associated with poor
outcome. The source of ascites infection, especially in case of culture-positive SBP and
bacterascites, is suspected to be bacterial translocation from gut.
In decompensated cirrhosis, data on the gut microbial translocation in different circulatory
compartments is limited. Moreover, the link between gut microbiome and systemic inflammation
in liver disease has still not established.
The transjugular intrahepatic portosystemic shunt (TIPS) is applied to treat portal
hypertension which frequently leads to intestinal bleeding, life-threatening esophageal
bleeding and ascites. Under the procedure of TIPS, the vein blood samples in different
compartments (superior mesenteric vein, portal vein and hepatic vein) from patients with
decompensated liver cirrhosis are available. Metagenomic next-generation sequencing (mNGS) is
a promise approach for the diagnosis of infectious disease because a comprehensive spectrum
of potential causes (viral, bacterial, fungal, and parasitic) can be identified by a single
assay. Previous study reported that mNGS of cerebrospinal fluid can be applied to diagnosis
of meningitis and encephalitis. Comparing to traditional bacterial culture method, mNGS
method is more sensitive and rapidly in pathogen detection. Therefore, the circulating
microbiome in different compartment can be characterized by means of mNGS.
Here, the study aim to investigate the circulating microbiome from superior mesenteric vein
(first venous outflow in gut-liver axis), hepatic vein (liver outflow), peripheral vein and
ascites from patients with decompensated liver cirrhosis receiving TIPS. Before TIPS, fecal
sample and unary sample are collected. And mNGS method is performed to identify the pathogen
in ascites,fecal and blood samples in a single center. Ultimately, the study aim to build up
the link between gut microbiome translocation and liver disease.
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