Gut Microbiota and Blood Biomarkers Predict Post-Stroke Infection in AIS Patients

Overview

This study evaluated the diagnostic potential of circulating biomarkers and gut microbiota profiling to predict post-stroke infections (PSI) in acute ischemic stroke (AIS) patients. Integrating gut microbiota features with blood biomarkers significantly improved early PSI prediction compared to single biomarker approaches.

Background

Post-stroke infection, including pneumonia and urinary tract infection, is a common complication after AIS that worsens outcomes and increases mortality. Traditional biomarkers like procalcitonin and CRP have limited specificity due to systemic inflammation after stroke. Emerging evidence suggests that gut microbiota dysbiosis and circulating markers reflecting gut barrier injury and immune activation may better predict PSI. Combining these biological domains may enhance risk stratification and guide preventive strategies.

Data Highlights

Key Findings

• Post-stroke infection occurred in 46.3% (37/80) of AIS patients within 7 days of admission.
• NMDAR antibody levels demonstrated the highest diagnostic accuracy for PSI (AUC 0.911, sensitivity 86.5%, specificity 90.7%).
• Gut microbiota analysis showed reduced evenness and dominance imbalance in infected patients, with enrichment of pathogenic taxa (Escherichia coli, Salmonella enterica) and depletion of SCFA-producing commensals (Faecalibacterium prausnitzii, Roseburia intestinalis).
• Circulating biomarkers reflecting intestinal barrier injury (iFABP) and endotoxemia (LPS) were significantly elevated in PSI and had high diagnostic performance (AUCs ~0.89).
• Multivariate logistic regression models integrating gut microbiota features with circulating biomarkers improved predictive accuracy beyond single-domain models.

Clinical Implications

Early identification of post-stroke infection risk can be enhanced by combining gut microbiota profiling with specific circulating biomarkers such as NMDAR antibodies, iFABP, and LPS. This integrated approach may enable more accurate risk stratification, allowing clinicians to implement targeted preventive measures and optimize post-stroke care. Routine use of combined biomarker–microbiota models could improve outcomes by facilitating timely diagnosis and intervention.

Conclusion

Integrating gut microbiota analysis with circulating biomarkers significantly improves early prediction of post-stroke infections in AIS patients. These findings support the role of the gut–brain–immune axis in post-stroke complications and endorse combined diagnostic models for enhanced clinical management.

References

1. Prof. Dr. dr. Mahar Mardjono National Brain Center Hospital Study 2023-2024 -- Diagnostic Potential of Gut Microbiota and Blood Biomarkers for PSI in AIS