{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:11:26Z","timestamp":1793293886023,"version":"4.5.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2019,8,20]],"date-time":"2019-08-20T00:00:00Z","timestamp":1566259200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,8,20]],"date-time":"2019-08-20T00:00:00Z","timestamp":1566259200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:p>Chronic alcohol consumption causes increased intestinal permeability and changes in the intestinal microbiota composition, which contribute to the development and progression of alcohol\u2010related liver disease. In this setting, little is known about commensal fungi in the gut. We studied the intestinal mycobiota in a cohort of patients with alcoholic hepatitis, patients with alcohol use disorder, and nonalcoholic controls using fungal\u2010specific internal transcribed spacer amplicon sequencing of fecal samples. We further measured serum anti\u2013<jats:italic toggle=\"yes\">Saccharomyces cerevisiae<\/jats:italic> antibodies (ASCA) as a systemic immune response to fungal products or fungi. <jats:italic toggle=\"yes\">Candida<\/jats:italic> was the most abundant genus in the fecal mycobiota of the two alcohol groups, whereas genus <jats:italic toggle=\"yes\">Penicillium<\/jats:italic> dominated the mycobiome of nonalcoholic controls. We observed a lower diversity in the alcohol groups compared with controls. Antibiotic or steroid treatment was not associated with a lower diversity. Patients with alcoholic hepatitis had significantly higher ASCA levels compared to patients with alcohol use disorder and to nonalcoholic controls. Within the alcoholic hepatitis cohort, patients with levels of at least 34 IU\/mL had a significantly lower 90\u2010day survival (59%) compared with those with ASCA levels less than 34 IU\/mL (80%) with an adjusted hazard ratio of 3.13 (95% CI, 1.11\u20108.82; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.031). <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> Patients with alcohol\u2010associated liver disease have a lower fungal diversity with an overgrowth of <jats:italic toggle=\"yes\">Candida<\/jats:italic> compared with controls. Higher serum ASCA was associated with increased mortality in patients with alcoholic hepatitis. Intestinal fungi may serve as a therapeutic target to improve survival, and ASCA may be useful to predict the outcome in patients with alcoholic hepatitis.<\/jats:p>","DOI":"10.1002\/hep.30832","type":"journal-article","created":{"date-parts":[[2019,6,22]],"date-time":"2019-06-22T12:20:37Z","timestamp":1561206037000},"page":"522-538","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":222,"title":["Intestinal Fungal Dysbiosis and Systemic Immune Response to Fungi in Patients With Alcoholic Hepatitis"],"prefix":"10.1097","volume":"71","author":[{"given":"Sonja","family":"Lang","sequence":"first","affiliation":[{"name":"Department of Medicine,University of California San Diego,La Jolla,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of California San Diego,La Jolla,CA"},{"name":"Department of Medicine,VA San Diego Healthcare System,San Diego,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinyuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health,University of California San Diego,San Diego,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manolito G.","family":"Torralba","sequence":"additional","affiliation":[{"name":"J. 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