Acute gastrointestinal injury and altered gut microbiota are related to sepsis-induced cholestasis in patients with intra-abdominal infection: a retrospective and prospective observational study.

BACKGROUND

Sepsis-associated liver dysfunction (SALD) has high incidence and mortality in patients with intra-abdominal infection (IAI). The associations between acute gastrointestinal injury (AGI), gut microbiota, and SALD were evaluated in patients with IAI.

METHODS

A retrospective study was conducted to assess the relationship between AGI and SALD in patients with IAI. Patients were divided into non-SALD and sepsis-induced cholestasis () groups, which is a subtype of SALD. was defined as total bilirubin >2 mg/dL. AGI incidences between the two groups were compared using Chi-square test. Subsequently, a prospective study was conducted to investigate the gut microbiota differences between patients without SALD and those with . Fecal samples were collected on days 1, 3, and 7 after admission to analyze changes in gut microbiota using 16S ribosomal ribonucleic acid sequencing.

RESULTS

One hundred thirty-four patients with IAI were included retrospectively, with 77 SALD and 57 non-SALD cases. Among patients with SALD, 71 were diagnosed with . Patients with had a higher incidence of AGI compared to those without SALD (28.07% vs. 56.34%,  < 0.05), and a severity-dependent relationship was found between AGI grade and occurrence. Subsequently, 20 patients with IAI were recruited prospectively, with 10 patients each assigned to the non-SALD and groups. Patients with had a more severe gut microbiota disorder on day 7 than those without SALD, including lower microbiota diversities, decreased abundance of and and increased abundance of and at the phylum level. Furthermore, and the two most abundant genera, were significantly higher in the group than in the non-SALD group. Functional prediction analysis showed that the top three KEGG pathways were ribosome, pyrimidine metabolism, and the two-component system. During the first week, the abundance of decreased significantly, whereas increased in the non-SALD group; however, the phyla taxa did not change significantly in the group.

CONCLUSION

There exists a severity-dependent relationship between AGI grade and occurrence in adult patients with IAI. A severe gut microbiota disorder was discovered in during the first week of the intensive care unit stay.