Cirrhosis is associated with changes in gut microbiome composition. Although ACLF is the most severe clinical stage of cirrhosis, there is lack of information about gut microbiome alterations in ACLF using quantitative metagenomics. To investigate the gut microbiome in patients with cirrhosis encompassing the whole spectrum of disease: compensated, acutely decompensated without ACLF, and ACLF. A group of healthy subjects was used as controls.