Gut Dysbiosis and Hemodynamic Changes as Links of the Pathogenesis of Complications of Cirrhosis

Abstract Background. Hemodynamic changes (hyperdynamic circulation) and gut dysbiosis are observed in cirrhosis. It was suggested that gut dysbiosis contributes to the development of hyperdynamic circulation, which aggravates the course of cirrhosis. The aim is to test this hypothesis.Methods. The cross-sectional observational study included 47 patients with cirrhosis. Stool microbiome was assessed using 16S rRNA gene sequencing. Echocardiography with a simultaneous assessment of blood pressure and heart rate was performed. Hemodynamic parameters were calculated. Results. Hyperdynamic circulation was found in 34% of patients. Patients with hyperdynamic circulation had higher incidences of clinically significant ascites (p=0.018), overt hepatic encephalopathy (p=0.042), hypoalbuminemia (p=0.011), hypoprothrombinemia (p=0.019), systemic inflammation (p=0.002), and severe hyperbilirubinemia (p=0.042) than patients without hyperdynamic circulation. The abundance of Proteobacteria (p=0.012), Enterobacteriaceae (p=0.008), Bacilli (p=0.027), Streptococcaceae (p=0.044), Lactobacillaceae (p=0.034), Enterococcaceae (p=0.046), and Fusobacteria (p=0.026) increased and the abundance of Bacteroidetes (p=0.049) and Erysipelotrichia (p=0.029) decreased in the gut microbiome of patients with hyperdynamic circulation compared to patients without hyperdynamic circulation. The systemic vascular resistance value negatively correlated with the abundance of Proteobacteria (r=-0.423; p=0.003), Enterobacteriaceae (r=-0.417; p=0.004), and Fusobacteria (r=-0.401; p=0.005). Heart rate was negatively correlated with the abundance of Bacteroidetes (r=-0.453; p=0.001). The cardiac output value was positively correlated with the abundance of Proteobacteria (r=0.402; p=0.003), Enterobacteriaceae (r=0.424; p=0.003), Fusobacteria (r=0.281; p=0.049), and Bacilli (r=0.314; p=0.031), and negatively correlated with the abundance of Bacteroidetes (r=-0.313; p=0.032) and Erysipelotrichia (r=-0.329; p=0.024). Conclusion. Gut dysbiosis is associated with hyperdynamic circulation, which is associated with a number of complications of cirrhosis.