The difference of plasma 16s ribosomal bacterial deoxyribonucleic acid level between cirrhotic patients with and without hepatic encephalopathy

Abstract

Background: Bacterial translocation (BT) and systemic inflammation play a key role in the pathogenesis of cirrhotic complications. The 16S ribosomal bacterial DNA (bactDNA) has been widely used as a marker of BT. The data on the relationship between BT, systemic inflammation and hepatic encephalopathy (HE) are scarce. This study aimed to assess the difference between plasma 16s ribosomal bactDNA and HE in patients with cirrhosis.

Method: Cirrhotic patients without bacterial infection were enrolled at Chulalongkorn University, Bangkok, Thailand, from August 2021 to December 2022. Grading of HE was classified by the West Haven Criteria and Psychometric hepatic encephalopathy score (PHES) ≤ -5. BactDNA, lipopolysaccharide-binding protein (LBP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), soluble CD14, and venous ammonia levels were all measured.

Results: Overall, 294 cirrhotic patients were enrolled, with 92 (31.3%) and 58 (19.7%) having covert and overt HE, respectively. BactDNA was found in 31.3%, 35.9%, and 48.3% of patients with no HE, covert HE and overt HE, respectively. Patients with overt HE had more bactDNA translocation, and higher levels of serum LBP, neutrophil-to-lymphocyte ratio, TNF-α, IL-6, and ammonia than those without HE. Patients with detectable bactDNA had higher white cell counts and serum LBP and IL-6 levels than those without. Levels of plasma bactDNA had a weak significantly positive correlation with venous ammonia, TNF-α and IL-6 (r=0.13-0.32, p0.05).

Conclusion: Apart from hyperammonemia, bactDNA translocation-related systemic inflammation might be a potential pathophysiological mechanism of overt HE in cirrhotic patients.