# A Metagenomics Approach to Frailty in Patients With Cirrhosis Undergoing a Multifactorial Intervention

## TL;DR

This study explores how gut microbiota relates to frailty in cirrhosis patients and finds that a 12-month intervention improves frailty alongside changes in the microbiome.

## Contribution

The study is the first to link frailty with gut microbiota in cirrhosis patients and shows that a multifactorial intervention can alter the microbiome and improve frailty.

## Key findings

- Frailty in cirrhosis patients is associated with specific gut microbiota signatures.
- A 12-month intervention improved frailty and altered microbiota composition, including increased Bifidobacterium and Lactobacillus species.
- Rothia dentocariosa and Bacteroides faecis were positively correlated with frailty measures like LFI and gait speed.

## Abstract

The relationship between frailty and gut microbiota has not been previously addressed in patients with cirrhosis. We studied by metagenomic shotgun sequencing the faecal microbiota composition associated with frailty in 29 patients with cirrhosis from a previous study (Román, Hepatol Commun 2024). Frail and prefrail patients were randomised to a multifactorial intervention (home exercise, branched‐chain amino acids and a multistrain probiotic) or control for 12 months. We observed a positive correlation between the abundance of
Rothia dentocariosa
and the Liver frailty index (LFI), and between
Bacteroides faecis
and gait speed. After the multifactorial intervention, LFI improved and the main changes in the microbiota composition were a decrease in the abundance of
Akkermansia muciniphila
, and an increase in
Streptococcus thermophilus
,
Lactobacillus acidophilus
and several species of Bifidobacterium. We conclude that frailty in patients with cirrhosis was associated with a distinct microbiome signature. After a long‐term multifactorial intervention, frailty improved in parallel with changes in microbiome composition.

Trial Registration:
ClinicalTrials.gov identifier: NCT04243148.