The impact of artificial liver support system on intestinal microbiota and serum bile acid profiles in patients with acute-on-chronic liver failure

Abstract Object: To observe the impact of artificial liver support system (ALSS) on the intestinal microbiota and serum bile acid (BA) profiles in patients with acute-on-chronic liver failure (ACLF), and to investigate the correlation between intestinal microbiota, serum BA profiles, and clinical outcomes in ACLF patients. Methods A prospective study was conducted to include 51 patients diagnosed with ACLF. These patients were stratified into two groups based on the utilization of ALSS during their treatment period: a standard medical treatment group (SMT group) comprising 19 patients and an ALSS combined with SMT group (ALSS group) encompassing 32 patients. Blood and stool samples were collected from the patients on the day of admission and 14 days after treatment. Additionally, 8 healthy controls were recruited, and their stool samples were collected. The intestinal microbiota was sequenced using the 16S rRNA sequencing technique, and the serum BA profiles were determined using the ultra-performance liquid chromatography/mass spectrometry. Results ACLF patients exhibited imbalances in intestinal microbiota and abnormalities in BA profiles. Compared to SMT alone, the combined ALSS and SMT is more effective in regulating intestinal microbiota imbalance and increasing the concentrations of ursodeoxycholic acid and glycoursodeoxycholic acid. There is a significant correlation between intestinal microbiota and serum BA profiles, with the presence of Faecalibaculum and Gemmiger , as well as taurochenodeoxycholic acid, being associated with clinical outcomes in ACLF patients. Conclusions Our study identified the compositional characteristics of the intestinal microbiota and serum BA in ACLF patients, emphasizing the impact of ALSS on both intestinal microbiota and serum BA profiles.