{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T21:55:09Z","timestamp":1780955709248,"version":"3.54.1"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","license":[{"start":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T00:00:00Z","timestamp":1661472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T00:00:00Z","timestamp":1661472000000},"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":["Liver Transpl"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Cirrhosis is complicated by a high rate of nosocomial infections (NIs), which result in poor outcomes and are challenging to predict using clinical variables alone. Our aim was to determine predictors of NI using admission serum metabolomics and gut microbiota in inpatients with cirrhosis. In this multicenter inpatient cirrhosis study, serum was collected on admission for liquid chromatography\u2013mass spectrometry metabolomics, and a subset provided stool for 16SrRNA analysis. Hospital course, including NI development and death, were analyzed. Metabolomic analysis using analysis of covariance (ANCOVA) (demographics, Model for End\u2010Stage Liver Disease [MELD] admission score, white blood count [WBC], rifaximin, and infection status adjusted) and random forest analyses for NI development were performed. Additional values of serum metabolites over clinical variables toward NI were evaluated using logistic regression. Stool microbiota and metabolomic correlations were compared in patients with and without NI development. A total of 602 patients (231 infection admissions) were included; 101 (17%) developed NIs, which resulted in worse inpatient outcomes, including intensive care unit transfer, organ failure, and death. A total of 127 patients also gave stool samples, and 20 of these patients developed NIs. The most common NIs were spontaneous bacterial peritonitis followed by urinary\u2009tract\u2009infection, <jats:italic toggle=\"yes\">Clostridioides difficile<\/jats:italic>, and pneumonia. A total of 247 metabolites were significantly altered on ANCOVA. Higher MELD scores (odds ratio, 1.05; <jats:italic toggle=\"yes\">p<\/jats:italic>\u2009&lt;\u20090.0001), admission infection (odds ratio, 3.54; <jats:italic toggle=\"yes\">p<\/jats:italic>\u2009&lt;\u20090.0001), and admission WBC (odds ratio, 1.05; <jats:italic toggle=\"yes\">p<\/jats:italic>\u00a0=\u00a00.04) predicted NI (area under the curve, 0.74), which increased to 0.77 (<jats:italic toggle=\"yes\">p<\/jats:italic>\u00a0=\u00a00.05) with lower 1\u2010linolenoyl\u2010glycerolphosphocholine (GPC) and 1\u2010stearoyl\u2010GPC and higher N\u2010acetyltryptophan and N\u2010acetyl isoputreanine. Commensal microbiota were lower and pathobionts were higher in those who developed NIs. Microbial\u2013metabolite correlation networks were complex and dense in patients with NIs, especially sub\u2010networks centered on Ruminococcaceae and Pseudomonadaceae. NIs are common and associated with poor outcomes in cirrhosis. Admission gut microbiota in patients with NIs showed higher pathobionts and lower commensal microbiota. Microbial\u2013metabolomic correlations were more complex, dense, and homogeneous among those who developed NIs, indicating greater linkage strength. Serum metabolites and gut microbiota on admission are associated with NI development in cirrhosis.<\/jats:p>","DOI":"10.1002\/lt.26552","type":"journal-article","created":{"date-parts":[[2022,7,30]],"date-time":"2022-07-30T04:29:04Z","timestamp":1659155344000},"page":"1831-1840","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":22,"title":["Association of serum metabolites and gut microbiota at hospital admission with nosocomial infection development in patients with cirrhosis"],"prefix":"10.1097","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3681","authenticated-orcid":false,"given":"Jasmohan S.","family":"Bajaj","sequence":"first","affiliation":[{"name":"Department of Medicine,Virginia Commonwealth University and Central Virginia Veterans Healthcare System,Richmond,Virginia,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4898-7778","authenticated-orcid":false,"given":"K. Rajender","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0486-0174","authenticated-orcid":false,"given":"Puneeta","family":"Tandon","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of Alberta,Edmonton,Alberta,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guadalupe","family":"Garcia\u2010Tsao","sequence":"additional","affiliation":[{"name":"Department of Medicine,Yale University Medical Center,New Haven,Connecticut,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick S.","family":"Kamath","sequence":"additional","affiliation":[{"name":"Department of Medicine,Mayo Clinic School of Medicine,Rochester,Minnesota,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline G.","family":"O'Leary","sequence":"additional","affiliation":[{"name":"Department of Medicine,Dallas Veterans Affairs Medical Center,Dallas,Texas,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9263-8869","authenticated-orcid":false,"given":"Florence","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of Toronto,Toronto,Ontario,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2092-6380","authenticated-orcid":false,"given":"Jennifer","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of California,San Francisco,California,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7802-688X","authenticated-orcid":false,"given":"Hugo","family":"Vargas","sequence":"additional","affiliation":[{"name":"Department of Medicine,Mayo Clinic,Phoenix,Arizona,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Thuluvath","sequence":"additional","affiliation":[{"name":"Department of Medicine,Mercy Medical Center,Baltimore,Maryland,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram M.","family":"Subramanian","sequence":"additional","affiliation":[{"name":"Department of Medicine,Emory University Medical Center,Atlanta,Georgia,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcela","family":"Pena\u2010Rodriguez","sequence":"additional","affiliation":[{"name":"LADEER,University of Guadalajara,Guadalajara,Jalisco,Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoumeh","family":"Sikaroodi","sequence":"additional","affiliation":[{"name":"Microbiome Analysis Center,George Mason University,Manassas,Virginia,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leroy R.","family":"Thacker","sequence":"additional","affiliation":[{"name":"Department of Medicine,Virginia Commonwealth University and Central Virginia Veterans Healthcare System,Richmond,Virginia,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick M.","family":"Gillevet","sequence":"additional","affiliation":[{"name":"Microbiome Analysis Center,George Mason University,Manassas,Virginia,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,8,26]]},"reference":[{"key":"lt26552-bib-0001-20250824","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1053\/j.gastro.2018.12.005","article-title":"Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide","volume":"156","year":"2019","journal-title":"Gastroenterology"},{"key":"lt26552-bib-0002-20250824","article-title":"Bacterial and fungal infections in acute\u2010on\u2010chronic liver failure: prevalence, characteristics and 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