Gut Microbiome Signatures Predict Long-Term Outcomes in Acute Pancreatitis

Many survivors later develop chronic or recurrent pancreatitis, diabetes, pancreatic cancer, or exocrine pancreatic insufficiency, but predicting which patients will be affected has been challenging. New research now shows that early microbial signatures in the gastrointestinal tract are linked to clinical outcomes in acute pancreatitis after hospital discharge.

The investigation, led by the University Medical Center Göttingen (UMG; Göttingen, Germany), developed a computer-assisted machine-learning model trained on gut microbiome data acquired at admission. The Europe-wide study involved 15 pancreatic centers and included 277 patients with acute pancreatitis. Microbiome profiling was performed within 72 hours of hospital arrival using oral and rectal swabs.

Bacterial DNA was sequenced with Oxford Nanopore technology, enabling analysis of long DNA fragments and species-level identification through bioinformatic methods. The model integrated the baseline microbial composition with complications recorded over three years after discharge and accounted for confounders such as age, gender, nicotine consumption, and antibiotic use. Early alterations in gut microbiota were significantly associated with subsequent outcomes; for example, among patients who later developed diabetes mellitus, 11 bacterial species were already more prevalent at admission.

Significant microbiome shifts were also observed in individuals who developed recurrent acute pancreatitis or who died during follow-up. The authors report that distinct microbial patterns at presentation correlated with different long-term complications. The work has been published in the journal Gut and was conducted under the leadership of UMG with participation from 15 pancreatic centers across Europe.

“Our results show a highly significant change in the gut microbiome in patients who later developed recurrent acute pancreatitis or diabetes mellitus, or even died. Thus, the microbial composition of the gut can predict the course of long-term complications at an early stage. The patterns of metabolic pathways that we were able to identify using bioinformatic prediction models provide initial indications that microbiome-induced metabolic pathways may contribute to long-term clinical complications,” said first author Dr. Christoph Ammer-Herrmenau.

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University Medical Center Göttingen