Dysbiosis of the intestinal microbiota in neurocritically ill patients and the risk for death
Dysbiosis of the intestinal microbiota in neurocritically ill patients and the risk for death
复制标题
神经重症患者肠道微生物群失调和死亡风险
DOI：
10.1186/s13054-019-2488-4
复制
发表时间：
2019-05-31
期刊：
影响因子：
15.1
通讯作者：
Yin, Jia
中科院分区：
文献类型：
--
作者：
Xu, Ruoting;Tan, Chuhong;Yin, Jia
背景：尽管肠道微生物群在人体生理学中具有重要功能，但关于神经危重症患者肠道微生物群的报道很少。本研究旨在评估神经危重症患者肠道微生物组的特征及其入院后的变化。此外，我们调查了入院时肠道微生物群的特征是否是180天内死亡的危险因素。方法：本前瞻性观察队列研究纳入广州某大型大学附属学术医院神经重症监护室收治的神经危重症患者。入院后（抗生素治疗前）72小时内收集粪便样本，每周连续收集一次。健康志愿者从广州的一个社区招募。通过16S rRNA基因序列分析监测肠道微生物组，并通过Cox比例风险模型评估其与临床结果的相关性。结果：共纳入98例患者和84例年龄和性别匹配的健康受试者。与健康受试者相比，神经危重症患者的肠道菌群组成存在显著差异。住院期间，瘤胃球菌科和毛螺科的α -多样性和丰度随时间的推移而显著下降。肠杆菌科的丰度与排出时改良的兰金量表呈正相关。在多变量Cox回归分析中，Christensenellaceae和丹毒科与死亡风险增加相关。在神经重症监护病房的第一周肠道肠杆菌和肠杆菌科的增加与调整后180天死亡率风险增加92%相关。结论：对98名神经危重症患者肠道微生物组的分析表明，这些患者的肠道微生物群组成与健康人群有显著差异，并且在神经重症监护病房住院期间，这种生态失调的程度增加。肠道菌群特征似乎对患者180天的死亡率有影响。肠道菌群分析有望预测未来的结果。
Background: Despite the essential functions of the intestinal microbiota in human physiology, little has been reported about the microbiome in neurocritically ill patients. This investigation aimed to evaluate the characteristics of the gut microbiome in neurocritically ill patients and its changes after admission. Furthermore, we investigated whether the characteristics of the gut microbiome at admission were a risk factor for death within 180days.Methods: This prospective observational cohort study included neurocritically ill patients admitted to the neurological intensive care unit of a large university-affiliated academic hospital in Guangzhou. Faecal samples were collected within 72h after admission (before antibiotic treatment) and serially each week. Healthy volunteers were recruited from a community in Guangzhou. The gut microbiome was monitored via 16S rRNA gene sequence analysis, and the associations with the clinical outcome were evaluated by a Cox proportional hazards model.Results: In total, 98 patients and 84 age- and sex-matched healthy subjects were included in the analysis. Compared with healthy subjects, the neurocritically ill patients exhibited significantly different compositions of intestinal microbiota. During hospitalization, the alpha-diversity and abundance of Ruminococcaceae and Lachnospiraceae decreased significantly over time in patients followed longitudinally. The abundance of Enterobacteriaceae was positively associated with the modified Rankin Scale at discharge. In the multivariate Cox regression analysis, Christensenellaceae and Erysipelotrichaceae were associated with an increased risk of death. The increases in intestinal Enterobacteriales and Enterobacteriaceae during the first week in the neurological intensive care unit were associated with increases of 92% in the risk of 180-day mortality after adjustments.Conclusions: This analysis of the gut microbiome in 98 neurocritically ill patients indicates that the gut microbiota composition in these patients differs significantly from that in a healthy population and that the magnitude of this dysbiosis increases during hospitalization in a neurological intensive care unit. The gut microbiota characteristics seem to have an impact on patients' 180-day mortality. Gut microbiota analysis could hopefully predict outcome in the future.