重症患者肠道微生物群的动态变化及其与死亡率的关系。

IF 4.3 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gut Pathogens Pub Date : 2023-12-19 DOI:10.1186/s13099-023-00567-8

Tarik J Salameh, Katharine Roth, Lisa Schultz, Zhexi Ma, Anthony S Bonavia, James R Broach, Bin Hu, Judie A Howrylak

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引用次数: 0

摘要

背景：重症监护室（ICU）内的重症疾病和护理会导致肠道微生物组的组成发生深刻变化。这种变化对患者及其后续病程的影响仍不确定。我们假设，肠道微生物组的特定变化比其他变化更有害，会导致重症患者的死亡率上升：这是一项针对重症监护室成人重症患者的前瞻性队列研究。我们采集了 52 名患者的直肠拭子，并使用 16 S rRNA 基因测序评估了肠道微生物组的组成。我们对患者的整个重症监护过程进行了跟踪，并在患者进入重症监护室 28 天后对其死亡率进行了评估。我们使用机器学习方法 selbal 来确定与 28 天死亡率关系最密切的微生物类群的平衡：结果：我们发现，四种分类群的比例可用于区分死亡风险较高的患者和死亡风险较低的患者（p = .02）。我们将这一二值化比率命名为微生物组死亡率指数（MMI）。与 MMI 值低的患者相比，MMI 值高的患者 28 天死亡率更高（危险比为 2.2，95% 置信区间为 1.1-4.3），而且在调整了其他 ICU 死亡率预测因素（包括急性呼吸窘迫综合征（ARDS）和急性生理学和慢性健康评估（APACHE II）评分）后，MMI 值仍然显著（危险比为 2.5，95% 置信区间为 1.4-4.7）。死亡率高的原因是厌氧球菌属（属）和肠杆菌科（科）的分类群，而死亡率低的原因是副球菌属和弯曲杆菌属：结论：危重症患者肠道菌群失调是导致其 28 天死亡率增加的独立风险因素。肠道菌群失调可能是未来重症监护病房干预措施的潜在治疗目标。

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Gut microbiome dynamics and associations with mortality in critically ill patients.

Background: Critical illness and care within the intensive care unit (ICU) leads to profound changes in the composition of the gut microbiome. The impact of such changes on the patients and their subsequent disease course remains uncertain. We hypothesized that specific changes in the gut microbiome would be more harmful than others, leading to increased mortality in critically ill patients.

Methods: This was a prospective cohort study of critically ill adults in the ICU. We obtained rectal swabs from 52 patients and assessed the composition the gut microbiome using 16 S rRNA gene sequencing. We followed patients throughout their ICU course and evaluated their mortality rate at 28 days following admission to the ICU. We used selbal, a machine learning method, to identify the balance of microbial taxa most closely associated with 28-day mortality.

Results: We found that a proportional ratio of four taxa could be used to distinguish patients with a higher risk of mortality from patients with a lower risk of mortality (p = .02). We named this binarized ratio our microbiome mortality index (MMI). Patients with a high MMI had a higher 28-day mortality compared to those with a low MMI (hazard ratio, 2.2, 95% confidence interval 1.1-4.3), and remained significant after adjustment for other ICU mortality predictors, including the presence of the acute respiratory distress syndrome (ARDS) and the Acute Physiology and Chronic Health Evaluation (APACHE II) score (hazard ratio, 2.5, 95% confidence interval 1.4-4.7). High mortality was driven by taxa from the Anaerococcus (genus) and Enterobacteriaceae (family), while lower mortality was driven by Parasutterella and Campylobacter (genera).

Conclusions: Dysbiosis in the gut of critically ill patients is an independent risk factor for increased mortality at 28 days after adjustment for clinically significant confounders. Gut dysbiosis may represent a potential therapeutic target for future ICU interventions.

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来源期刊

Gut Pathogens GASTROENTEROLOGY & HEPATOLOGY-MICROBIOLOGY

CiteScore

7.70

自引率

2.40%

发文量

期刊介绍： Gut Pathogens is a fast publishing, inclusive and prominent international journal which recognizes the need for a publishing platform uniquely tailored to reflect the full breadth of research in the biology and medicine of pathogens, commensals and functional microbiota of the gut. The journal publishes basic, clinical and cutting-edge research on all aspects of the above mentioned organisms including probiotic bacteria and yeasts and their products. The scope also covers the related ecology, molecular genetics, physiology and epidemiology of these microbes. The journal actively invites timely reports on the novel aspects of genomics, metagenomics, microbiota profiling and systems biology. Gut Pathogens will also consider, at the discretion of the editors, descriptive studies identifying a new genome sequence of a gut microbe or a series of related microbes (such as those obtained from new hosts, niches, settings, outbreaks and epidemics) and those obtained from single or multiple hosts at one or different time points (chronological evolution).