Letter to the editor regarding “Structural and functional alteration of the gut microbiomes in ICU staff: a cross-sectional analysis”

Abstract

Dear Editor,

I read with great interest the study by Xie et al. published in Critical Care and carefully reviewed their clinical trial registration details (NCT06524765) [1]. Although this study holds significant clinical value, there are still certain issues that need to be addressed.

First, it appears that there may be some deviations from the clinical trial protocol provided (NCT06524765). According to the study protocol, the primary outcome was defined as the difference in ARGs abundance; however, this outcome does not seem to have been fully addressed in the study. Additionally, several secondary outcomes were not presented. Specifically, important metrics related to quality-of-life assessments, including the Patient Health Questionnaire (PHQ-9) score, Symptom Checklist 90 (SCL-90) score, Perceived Stress Scale (PSS) score, International Physical Activity Questionnaire (IPAQ) score, and Pittsburgh Sleep Quality Index (PSQI) score, appear to be missing. These omissions raise some questions regarding the completeness of the study’s findings.

Second, the authors claim that gender is the factor influencing microbiome differences among healthcare workers. Given that the majority of nurses in China are female, the observed differences could potentially be attributed to occupational characteristics rather than solely to gender. It would be helpful if the authors could provide additional details on the occupational categories of male and female healthcare workers to further clarify this issue.

Finally, the authors did not make any multiple corrections to the P-value in this study. In microbiome research, multiple testing corrections for p-values should be applied to decrease the probability of false positives, making the final conclusions more reliable. Besides, it seems that a sample size calculation based on the primary outcome was not conducted. Considering that a sample size of 40 is relatively small for a microbiome study, this may have an impact on the statistical robustness of the results. For instance, while the authors suggest that there is no statistically significant difference in ARGs between healthcare workers and healthy individuals, this result could potentially be influenced by the sample size, which may not be sufficient to detect such differences.

I hope the authors can take these issues into careful consideration.

None

1. Xie B, Dong C, Zhao X, et al. Structural and functional alteration of the gut microbiomes in ICU staff: a cross-sectional analysis. Crit Care. 2025;29:141.

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Authors and Affiliations

1. Department of Critical Care Medicine, Henan Key Laboratory for Critical Care Medicine, Zhengzhou Key Laboratory for Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China

   Wenxiao Zhang

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1. Wenxiao ZhangView author publications

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Wenxiao Zhang participated in the discussion and wrote the manuscript.

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Correspondence to Wenxiao Zhang.

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Zhang, W. Letter to the editor regarding “Structural and functional alteration of the gut microbiomes in ICU staff: a cross-sectional analysis”. Crit Care 29, 161 (2025). https://doi.org/10.1186/s13054-025-05418-3

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• Received: 11 April 2025

• Accepted: 14 April 2025

• Published: 23 April 2025

• DOI: https://doi.org/10.1186/s13054-025-05418-3

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