Objective:

To evaluate the diagnostic value of circulating biomarkers and gut microbiota profiling, both individually and in combination, for predicting post-stroke infections (PSI) in acute ischemic stroke (AIS) patients.

Key Findings:

• PSI occurred in 46.3% of patients (37 out of 80), indicating a significant risk.
• NMDAR showed the highest diagnostic performance (AUC 0.911; sensitivity 86.5%; specificity 90.7), suggesting its potential as a reliable biomarker.
• Gut microbiota analysis indicated reduced evenness and dominance imbalance in infected patients, with enrichment of pathogenic taxa such as Escherichia coli and Salmonella enterica.

Interpretation:

Integrating circulating biomarkers with gut microbiota profiling significantly enhances early prediction of PSI in AIS, highlighting the gut–brain–immune axis's role in post-stroke complications and its potential implications for clinical practice.

Limitations:

• Study conducted at a single center, which may limit generalizability and introduce selection bias.
• Sample size may not be sufficient for broader conclusions, potentially affecting the robustness of the findings.

Conclusion:

Combined biomarker-microbiota models improve risk stratification and preventive strategies for post-stroke infections, emphasizing the need for further research to validate these findings in larger, diverse populations.