*Nonalcoholic Fatty Liver Disease, Procalcitonin, and Gut Microbiota: Players in the Same Team DOI: http://dx.doi.org/10.5772/intechopen.110134*

As seen in **Table 1**, that illustrates demographic and biological baseline aspects in all research participants, patients either dysbiotic or not displayed significant differences when compared with controls, related to several variables, such as ALT, FPG, HbA1C, LDL, and HDL-cholesterol, triglycerides, creatinine, microproteinuria, CRP, and PCT. However, no significant differences were noted when compared patients' age, gender, location, and complete blood count (CBC), to those of control's group. Dysbiotic patients from the study group displayed significant elevation of PCT, C-reactive protein (CRP), and cytolytic enzymes: alanine aminotransferase (ALT), LDL-cholesterol, triglycerides, and HbA1c when compared to patients with NAFLD and no dysbiosis. No significant statistical differences were recorded between dysbiotic and normobiotic patients related to age, gender, location, CBC, creatinine, and HDL-cholesterol.

As seen in **Table 2**, that depicts the comparison of several clinical studied in patients included in this study, patients from dysbiotic group exhibited significant differences related to higher FLI, severity of fatty liver either simple steatosis or NASH, as well as less frequent treatment with biguanides and statins. The other variables, such as smoking history, sedentary life style, obesity, dyslipidemia, hypertension, G-I associated conditions, GSD, T2DM, IGT, CKD, and cardiovascular conditions, showed comparable results when compared dysbiotic patients with those with normobiosis.

As presented in **Table 3**, that displays stool's microbiota main alterations in patients with NAFLD and associated gut dysbiosis, the gut microbiome of the study


*DB = dysbiosis, BMI = body mass index, HT = hypertension, NASH = nonalcoholic steatohepatitis, G-I = gastrointestinal, GSD = gallstone disease, T2DM/IGT = type 2 diabetes mellitus/Impaired glucose tolerance, CKD = chronic kidney disease, C-V = cardiovascular, p bold = significant difference.*

### **Table 2.**

*Clinical baseline aspects in patients with NAFLD.*

*Nonalcoholic Fatty Liver Disease, Procalcitonin, and Gut Microbiota: Players in the Same Team DOI: http://dx.doi.org/10.5772/intechopen.110134*


### **Table 3.**

*Stool's microbiota bioindicator alterations in dysbiotic patients.*

#### **Figure 1.**

*Distribution of enterotypes in dysbiotic patients with NAFLD.*

group was characterized by several alterations, expressed either by the decrease of various bioindicators, such as H index of biodiversity, observed in 76% of patients, *Akkermansia muciniphila* sp*.* in 62% of patients, and F/B ratio in 64%, or by the increase of LPS (+) bacteria in 60% of patients.

The study of the stool's microbiota enterotypes based on the mathematical analysis of the proportional relationship between *Bacteroides* sp., *Prevotella* sp., and *Ruminococcus* sp. in dysbiotic patients with NAFLD was expressed in percentages and is depicted in **Figure 1**.

As seen in **Figure 1**, patients with NAFLD and gut microbiota dysbiosis were characterized by a microbiological picture in which predominated *Bacteroides* sp. and *Prevotella* spp. dominant enterotype, observed in 74% of cases. *Ruminococcus spp.* dominant enterotype was noted in only 26% of cases.

Correlations of PCT to several blood biological variables such as CRP and ALT, as well as to stool's microbiota variables like F/B ratio, and H index of alpha biodiversity were analyzed in dysbiotic patients with NAFLD and are displayed in **Figure 2**.

As illustrated in **Figure 2**, PCT positively strong correlated (p < 0.0001) to the serum levels of ALT and to the F/B ratio of the gut microbiome (p < 0.0001). PCT also positively strong correlated with the stool's microbiota dysbiosis bioindicator, represented by the H index of alpha biodiversity (p = 0.005) and to the serum levels of CRP (p = 0.0031).

**Figure 3** depicts the correlations of the gut microbiota dysbiosis intensity to Fibromax analyzed scores, such as SteatoTest, that expressed the severity of simple

### **Figure 2.**

*Correlations of PCT in patients with NAFLD and gut dysbiosis.*

**Figure 3.** *Correlations of severity to steatosis and NASH scores.*

steatosis, and NashTest, that expressed the level of necro-inflammatory activity caused by the metabolic condition.

As illustrated in **Figure 3,** significantly positive correlations were noted between the severity of gut microbiota dysbiosis and the NASH scores according to Fibromax test, but no significant correlations were observed between the gut microbiota dysbiosis range and the severity of simple steatosis, represented by SteatoTest scores.
