Fecal cytolysin does not predict disease severity in acutely decompensated cirrhosis and acute-on-chronic liver failure
Phillipp Hartmann a , b , Sonja Lang c , d , Robert Schierwagen e , Sabine Klein e , Michael Praktiknjo e , Jonel Trebicka e , f , Bernd Schnabl c , g , ∗
a Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
b Division of Gastroenterology, Hepatology & Nutrition, Rady Children’s Hospital San Diego, San Diego, CA, USA
c Department of Medicine, University of California San Diego, La Jolla, CA, USA
d Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
e Department of Internal Medicine B, University of Münster, Münster, Germany
f European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
g Department of Medicine, VA San Diego Healthcare System, San Diego, CA, USA
∗Corresponding author at: Department of Medicine, University of California San Diego, MC0063, 9500 Gilman Drive, La Jolla, CA 92093, USA
E-mail address: beschnabl@ucsd.edu (B. Schnabl).
Abstract：Background: Cirrhosis with acute decompensation (AD) and acute-on-chronic liver failure (ACLF) are characterized by high morbidity and mortality. Cytolysin, a toxin from Enterococcus faecalis ( E. faecalis ), is associated with mortality in alcohol-associated hepatitis (AH). It is unclear whether cytolysin also contributes to disease severity in AD and ACLF.
Methods: We studied the role of fecal cytolysin in 78 cirrhotic patients with AD/ACLF. Bacterial DNA from fecal samples was extracted and real-time quantitative polymerase chain reaction (PCR) was performed. The association between fecal cytolysin and liver disease severity in cirrhosis with AD or ACLF was analyzed.
Results: Fecal cytolysin and E. faecalis abundance did not predict chronic liver failure (CLIF-C) AD and ACLF scores. Presence of fecal cytolysin was not associated with other liver disease markers, including Fibrosis-4 (FIB-4) index, ‘Age, serum Bilirubin, INR, and serum Creatinine (ABIC)’ score, Child-Pugh score, model for end-stage liver disease (MELD) nor MELD-Na scores in AD or ACLF patients.
Conclusions: Fecal cytolysin does not predict disease severity in AD and ACLF patients. The predictive value of fecal cytolysin positivity for mortality appears to be restricted to AH.
2023, Vol. 22 
