- 1Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA.
- 2Department of Medicine, University of Pittsburgh, Pittsburgh, USA.
- 3Microbiome Analysis Center, George Mason University, Manassas, Virginia, USA.
Background: Neighborhood deprivation has been associated with chronic diseases and with gut microbial alterations. While cirrhosis is associated with gut microbiome changes, and hepatic encephalopathy (HE); their association is unclear.
Methods: Demographics and cirrhosis details (MELD, prior HE, medications) were recorded from outpatients with cirrhosis. Area deprivation index (ADI), which ranks neighborhoods by socioeconomic disadvantage, was recorded as state decile and national percentile (high=worse for both) and dichotomized on the median. Patients underwent cognitive testing to diagnose minimal HE (MHE). Stool microbiota was analyzed using 16SrRNA for α/β diversity. Multi-variable analysis were used to evaluate the factors independently associated with MHE.
Results: 321 people with cirrhosis (60 years, 78% men, 75% non-Hispanic white, 24% non-Hispanic African-American, 4% Hispanic) were included. 45% had prior HE and 56% MHE. ADI: National percentile was 49.1±21.8 while state decile was 6.1±2.3. ADI was not associated with race, ethnicity, MELD or HE-related variables on regression.
Microbiota: α-diversity was lower in MHE and prior HE patients but similar across ADI rankings. Low vs high ADI were associated with different β-diversity in univariable but not multivariable analyses. Multivariable analyses showed positive associations with MELD, prior HE, and lactate producers (Lactobacilllus, Lacticaseibacillus) and negative associations with short-chain fatty acid producers (Blautia, Lachnoclostridium, Anaerobutyricum) with MHE.
Conclusions: Cirrhosis-related variables may be more influential in determining gut microbiome composition and cognitive impairment than ADI. Therefore, the focus should be on improving cirrhosis care regardless of ADI, but studies evaluating other measures of social determinants are needed in cirrhosis.