By integrating microbiome strain and functional profiles with detailed clinical data, including disease severity indices (Child–Pugh and Model for End-Stage Liver Disease (MELD) scores) and a small-intestinal epithelial cell damage marker (plasma fatty acid binding protein 2 (FABP2)), we identified a bacterial collagenase-like proteinase (prtC encoded) associated with disease pathobiology. This evidence concerns the gene FABP2 and End Stage Liver Disease.