{
  "abstract": "Background Postdischarge morbidity and mortality is high in acute pancreatitis (AP) and pathophysiological mechanisms remain poorly understood.Objectives We aim to investigate the composition of gut microbiota and clinical long-term outcomes of prospectively enrolled patients with AP to predict postdischarge complications.Design In this long-term follow-up study, we analysed clinical and microbiome data of 277 patients from the prospective multicentre Pancreatitis-Microbiome As Predictor of Severity trial. The primary endpoint was the association of the microbial composition with postdischarge mortality, recurrent AP (RAP), progression to chronic pancreatitis, pancreatic exocrine insufficiency, diabetes mellitus (DM) and pancreatic ductal adenocarcinoma.Results Buccal (n=238) and rectal (n=249) swabs were analysed by 16S rRNA and metagenomics sequencing using Oxford Nanopore Technologies. Median follow-up was 2.8 years. Distance-based redundancy analysis with canonical analysis of principal coordinates showed significant differences for β-diversity (Bray-Curtis) for postdischarge mortality (p=0.04), RAP (p=0.02) and DM (p=0.03). A ridge regression model including 11 differentially abundant species predicted postdischarge DM with an area under the receiving operating characteristic of 94.8% and 86.2% in the matched and entire cohort, respectively. Using this classifier, a positive predictive value of 66.6%, a negative predictive value of 96% and an accuracy of 95% was achieved.Conclusion Our data indicate that the admission microbiome of patients with AP correlates with postdischarge complications independent from multiple risk factors such as AP severity, smoking or alcohol. Microbiota at admission show excellent capacity to predict postdischarge DM and may thus open new stratification tools for a tailored risk assessment in the future.Trial registration number NCT04777812.",
  "authors": [
    {
      "affiliations": [
        "Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Goettingen, NDS, Germany"
      ],
      "name": "Christoph Ammer-Herrmenau"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Goettingen, NDS, Germany"
      ],
      "name": "Richard Meier"
    },
    {
      "affiliations": [
        "Medical Statistics, University Medical Center Göttingen, Goettingen, NDS, Germany"
      ],
      "name": "Kai L Antweiler"
    },
    {
      "affiliations": [
        "Gastroenterology, University Medical Center Göttingen, Goettingen, NDS, Germany"
      ],
      "name": "Thomas Asendorf"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Goettingen, NDS, Germany"
      ],
      "name": "Silke Cameron"
    },
    {
      "affiliations": [
        "3Pancreato-Biliar Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, Scientific Institute San Raffaele, Milan, Italy",
        "Vita-Salute San Raffaele University, Milan, Lombardy, Italy"
      ],
      "name": "Gabriele Capurso"
    },
    {
      "affiliations": [
        "Internal Medicine I, University Hospital Halle, Halle, Germany"
      ],
      "name": "Marko Damm"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Goettingen, NDS, Germany"
      ],
      "name": "Linh Dang"
    },
    {
      "affiliations": [
        "Department of Medicine A, Universitätsmedizin Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany"
      ],
      "name": "Fabian Frost"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Goettingen, NDS, Germany"
      ],
      "name": "Jacob Hamm"
    },
    {
      "affiliations": [
        "Medical Department II, Division of Gastroenterology, University of Leipzig Faculty of Medicine, Leipzig, SN, Germany"
      ],
      "name": "Albrecht Hoffmeister"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Rostock University Medical Center, Rostock, Germany"
      ],
      "name": "Yana Kocheva"
    },
    {
      "affiliations": [
        "University Clinic of Internal Medicine—Gastroenterology, University of Oldenburg School VI—Medicine and Health Sciences, Oldenburg, NDS, Germany"
      ],
      "name": "Christian Meinhardt"
    },
    {
      "affiliations": [
        "Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Swietokrzyskie, Poland"
      ],
      "name": "Lukasz Nawacki"
    },
    {
      "affiliations": [
        "Department of Surgery, Professor Doctor Fernando Fonseca Hospital, Amadora, Lisboa, Portugal"
      ],
      "name": "Vitor Nunes"
    },
    {
      "affiliations": [
        "University Hospital Bratislava, Bratislava, Bratislava Region, Slovakia",
        "4th Department of Surgery, Comenius University in Bratislava Faculty of Medicine, Bratislava, Slovakia"
      ],
      "name": "Arpad Panyko"
    },
    {
      "affiliations": [
        "Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, Spain"
      ],
      "name": "María Lourdes Ruiz-Rebollo"
    },
    {
      "affiliations": [
        "Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, Spain"
      ],
      "name": "Cesáreo Flórez-Pardo"
    },
    {
      "affiliations": [
        "Clinical Department of Internal Medicine II, TUM School of Medicine and Health, Munich, BY, Germany"
      ],
      "name": "Veit Phillip"
    },
    {
      "affiliations": [
        "Center of Gastroenterology, Hepatology and Nutrition, Paul Stradins Clinical University Hospital, Riga, Riga, Latvia"
      ],
      "name": "Aldis Pukitis"
    },
    {
      "affiliations": [
        "Center of Gastroenterology, Hepatology and Nutrition, Paul Stradins Clinical University Hospital, Riga, Riga, Latvia"
      ],
      "name": "Diana Vaselane"
    },
    {
      "affiliations": [
        "Clinical Emergency Hospital Bucharest, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Bucharest, Romania"
      ],
      "name": "Ecaterina Rinja"
    },
    {
      "affiliations": [
        "Clinical Emergency Hospital Bucharest, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Bucharest, Romania",
        "Gastroenterology SCUB, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania"
      ],
      "name": "Vasile Sandru"
    },
    {
      "affiliations": [
        "Department of Medicine II, LMU Munich, Munich, BY, Germany"
      ],
      "name": "Arlett Schaefer"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Goettingen, NDS, Germany"
      ],
      "name": "Rahel Scholz"
    },
    {
      "affiliations": [
        "Medical Department II, University Hospital Leipzig, Leipzig, SN, Germany"
      ],
      "name": "Julian Seelig"
    },
    {
      "affiliations": [
        "Department of Medicine II, LMU Munich, Munich, BY, Germany"
      ],
      "name": "Simon Sirtl"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Goettingen, NDS, Germany"
      ],
      "name": "Volker Ellenrieder"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Goettingen, NDS, Germany"
      ],
      "name": "Albrecht Neesse"
    }
  ],
  "title": "Gut microbiota predict development of postdischarge diabetes mellitus in acute pancreatitis",
  "uid": "7f4cf847-1407-5815-a628-7fe8b4736443"
}