Dysbiosis of Gut Microbiota Is an Independent Risk Factor of Stroke-Associated Pneumonia: A Chinese Pilot Study

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study design
Citation
PMID PubMed identifier for scientific articles.
DOI Digital object identifier for electronic documents.
URI
Authors
Xia GH, Zhang MS, Wu QH, Wang HD, Zhou HW, He Y, Yin J
Journal
Frontiers in cellular and infection microbiology
Year
2021
Keywords:
gut microbiota, risk, short-chain fatty acids, stroke, stroke-associated pneumonia
BACKGROUND AND PURPOSE: Identifying risks of stroke-associated pneumonia (SAP) is important for clinical management. We aimed to evaluate the association between gut microbiome composition and SAP in patients with acute ischemic stroke (AIS). METHODS: A prospective observational study was conducted, and 188 AIS patients were enrolled as the training cohort. Fecal and serum samples were collected at admission. SAP was diagnosed by specialized physicians, and disease severity scores were recorded. Fecal samples were subjected to 16S rRNA V4 tag sequencing and analysed with QIIME and LEfSe. Associations between the most relevant taxa and SAP were analysed and validated with an independent cohort. Fecal short-chain fatty acid (SCFA), serum D-lactate (D-LA), intestinal fatty acid-binding protein (iFABP) and lipopolysaccharide binding protein (LBP) levels were measured. RESULTS: Overall, 52 patients (27.7%) had SAP in the training cohort. The gut microbiome differed between SAP and non-SAP patients; specifically, Roseburia depletion and opportunistic pathogen enrichment were noted in SAP patients, as confirmed in the validation cohort (n=144, 28 SAP [19.4%]). Based on multivariate analysis, Roseburia was identified as a protective factor against SAP in both cohorts (training, aOR 0.52; 95% CI, 0.30-0.90; validation, aOR 0.44; 95% CI, 0.23-0.85). The combination of these taxa into a microbial dysbiosis index (MDI) revealed that dysbiosis increased nearly 2 times risk of SAP (training, aOR 1.95; 95% CI, 1.19-3.20; validation, aOR 2.22; 95% CI, 1.15-4.26). Lower fecal SCFA levels and higher serum D-LA levels were observed in SAP patients. Furthermore, SAP was an independent risk factor of 30-day death and 90-day unfavorable outcome. CONCLUSION: We demonstrate that a microbial community with depleted Roseburia and enriched opportunistic pathogens is associated with increased risk of SAP among AIS patients. Gut microbiota screening might be useful for identifying patients at high risk for SAP and provide clues for stroke treatment.

Experiment 1


Reviewed Marked as Reviewed by Svetlana up on 2025-1-10

Curated date: 2024/10/14

Curator:

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Subjects

Location of subjects
China
Host species Species from which microbiome was sampled. Contact us to have more species added.
Homo sapiens
Body site Anatomical site where microbial samples were extracted from according to the Uber Anatomy Ontology
Feces Cow dung,Cow pat,Droppings,Dung,Excrement,Excreta,Faeces,Fecal material,Fecal matter,Fewmet,Frass,Guano,Matières fécales@fr,Merde@fr,Ordure,Partie de la merde@fr,Piece of shit,Porción de mierda@es,Portion of dung,Portion of excrement,Portion of faeces,Portion of fecal material,Portion of fecal matter,Portion of feces,Portion of guano,Portion of scat,Portionem cacas,Scat,Spoor,Spraint,Stool,Teil der fäkalien@de,Feces,feces
Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Cerebrovascular disorder
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Non-Stroke Associated Pneumonia (non-SAP) Training cohort
Group 1 name Corresponds to the case (exposed) group for case-control studies
Stroke Associated Pneumonia (SAP) Training cohort
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Patients with acute ischemic stroke (AIS) as the Training cohort .
Group 0 sample size Number of subjects in the control (unexposed) group
136
Group 1 sample size Number of subjects in the case (exposed) group
52
Antibiotics exclusion Number of days without antibiotics usage (if applicable) and other antibiotics-related criteria used to exclude participants (if any)
3 Month

Lab analysis

Sequencing type
16S
16S variable region One or more hypervariable region(s) of the bacterial 16S gene
V4
Sequencing platform Manufacturer and experimental platform used for quantifying microbial abundance
Illumina

Statistical Analysis

Data transformation Data transformation applied to microbial abundance measurements prior to differential abundance testing (if any).
relative abundances
Statistical test
LEfSe
Significance threshold p-value or FDR threshold used for differential abundance testing (if any)
0.10
MHT correction Have statistical tests be corrected for multiple hypothesis testing (MHT)?
No
LDA Score above Threshold for the linear discriminant analysis (LDA) score for studies using the popular LEfSe tool
4.0


Signature 1

Reviewed Marked as Reviewed by Svetlana up on 2025-1-10

Curated date: 2024/10/14

Curator: Rahila

Revision editor(s): Rahila, WikiWorks

Source: FIG 2 (B)

Description: Comparison of the microbial communities of the SAP and non-SAP groups in the training cohort using LEfSe to identified the 13 most differentially abundant taxa.

Abundance in Group 1: increased abundance in

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Bacilli
Bilophila
Enterobacterales
Enterobacteriaceae
Enterococcus
Erwinia
Gammaproteobacteria
Lactobacillales
Parabacteroides
Porphyromonadaceae
Pseudomonadota
Enterococcaceae

Revision editor(s): Rahila, WikiWorks

Signature 2

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Curated date: 2024/10/14

Curator: Rahila

Revision editor(s): Rahila, WikiWorks

Source: FIG 2 (B)

Description: Comparison of the microbial communities of the SAP and non-SAP groups in the training cohort using LEfSe to identified the 13 most differentially abundant taxa.

Abundance in Group 1: decreased abundance in

NCBI Quality ControlLinks
Roseburia

Revision editor(s): Rahila, WikiWorks

Experiment 2


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Curated date: 2024/10/14

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Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Non-Stroke Associated Pneumonia (non-SAP) independent cohort
Group 1 name Corresponds to the case (exposed) group for case-control studies
Stroke Associated Pneumonia (SAP) independent cohort
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Patients with acute ischemic stroke (AIS) as the independent cohort .
Group 0 sample size Number of subjects in the control (unexposed) group
116
Group 1 sample size Number of subjects in the case (exposed) group
28

Lab analysis

Statistical Analysis

LDA Score above Threshold for the linear discriminant analysis (LDA) score for studies using the popular LEfSe tool
2.0


Signature 1

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Curated date: 2024/10/14

Curator: Rahila

Revision editor(s): Rahila, WikiWorks

Source: Figure (S2B)

Description: Comparison of the microbial communities of the SAP and non-SAP groups in the validation cohort using LEfSe to identified the most differentially abundant taxon between the two groups.

Abundance in Group 1: increased abundance in

NCBI Quality ControlLinks
Desulfovibrio
Enterobacterales
Enterobacteriaceae
Gammaproteobacteria
Lactobacillales
Pseudomonadota
Rikenellaceae
Enterobacter
Lactobacillus
Lactobacillaceae

Revision editor(s): Rahila, WikiWorks

Signature 2

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Curated date: 2024/10/14

Curator: Rahila

Revision editor(s): Rahila, WikiWorks

Source: Figure (S2B)

Description: Comparison of the microbial communities of the SAP and non-SAP groups in the validation cohort using LEfSe to identified the most differentially abundant taxon between the two groups.

Abundance in Group 1: decreased abundance in

NCBI Quality ControlLinks
Bacteroidaceae
Bacteroides
Bacteroidia
Bacteroidales
Pasteurellales
Pasteurellaceae
Haemophilus
Burkholderiales
Betaproteobacteria
Sutterella
Alcaligenaceae
Roseburia
Lachnospira
Coprococcus

Revision editor(s): Rahila, WikiWorks

Experiment 3


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Curated date: 2024/10/15

Curator:

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Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Non-Stroke Associated Pneumonia (non-SAP) subgroup in the training cohort
Group 1 name Corresponds to the case (exposed) group for case-control studies
Stroke Associated Pneumonia (SAP) subgroup in the training cohort
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Patients with acute ischemic stroke (AIS) as the subgroup in the training cohort.
Group 0 sample size Number of subjects in the control (unexposed) group
25
Group 1 sample size Number of subjects in the case (exposed) group
25

Lab analysis

Statistical Analysis

Matched on Factors on which subjects have been matched on in a case-control study
age, Matched on: "NIHSS" is not in the list (abnormal glucose tolerance, acetaldehyde, acute graft vs. host disease, acute lymphoblastic leukemia, acute myeloid leukemia, adenoma, age, AIDS, alcohol consumption measurement, alcohol drinking, ...) of allowed values.NIHSS, Matched on: "dysphagia" is not in the list (abnormal glucose tolerance, acetaldehyde, acute graft vs. host disease, acute lymphoblastic leukemia, acute myeloid leukemia, adenoma, age, AIDS, alcohol consumption measurement, alcohol drinking, ...) of allowed values.dysphagia


Signature 1

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Curated date: 2024/10/15

Curator: Rahila

Revision editor(s): Rahila, KateRasheed, WikiWorks

Source: Figure S4B

Description: Comparison of the microbial communities of the SAP and non-SAP groups in the subset of the training cohort using LEfSe to identified the most differentially abundant taxon between the two groups.

Abundance in Group 1: increased abundance in

NCBI Quality ControlLinks
Aeromonadales
Enterococcaceae
Enterococcus
Erwinia
Succinivibrio

Revision editor(s): Rahila, KateRasheed, WikiWorks

Signature 2

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Curated date: 2024/10/15

Curator: Rahila

Revision editor(s): Rahila, KateRasheed, WikiWorks

Source: Figure S4B

Description: Comparison of the microbial communities of the SAP and non-SAP groups in the subset of the training cohort using LEfSe to identified the most differentially abundant taxon between the two groups.

Abundance in Group 1: decreased abundance in

NCBI Quality ControlLinks
Dehalobacterium
Faecalibacterium
Roseburia
DehalobacteriaceaeDehalobacteriaceae

Revision editor(s): Rahila, KateRasheed, WikiWorks

Experiment 4


Reviewed Marked as Reviewed by Svetlana up on 2025-1-10

Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Non-Stroke Associated Pneumonia (non-SAP) Training cohort
Group 1 name Corresponds to the case (exposed) group for case-control studies
Stroke Associated Pneumonia (SAP) Training cohort
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Patients with acute ischemic stroke (AIS) as the Training cohort .
Group 0 sample size Number of subjects in the control (unexposed) group
136
Group 1 sample size Number of subjects in the case (exposed) group
52
Antibiotics exclusion Number of days without antibiotics usage (if applicable) and other antibiotics-related criteria used to exclude participants (if any)
3 months

Lab analysis

Statistical Analysis

Statistical test
Mann-Whitney (Wilcoxon)
LDA Score above Threshold for the linear discriminant analysis (LDA) score for studies using the popular LEfSe tool
Not specified
Matched on Factors on which subjects have been matched on in a case-control study
Not specified


Signature 1

Reviewed Marked as Reviewed by Svetlana up on 2025-1-10

Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Source: Fig. 2C

Description: Comparison of the microbial communities of the SAP and non-SAP groups in the training cohort using Mann-Whitney

Abundance in Group 1: decreased abundance in Stroke Associated Pneumonia (SAP) Training cohort

NCBI Quality ControlLinks
Roseburia

Revision editor(s): KateRasheed, WikiWorks

Signature 2

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Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Source: Fig. 2C

Description: Comparison of the microbial communities of the SAP and non-SAP groups in the training cohort using Mann-Whitney

Abundance in Group 1: increased abundance in Stroke Associated Pneumonia (SAP) Training cohort

NCBI Quality ControlLinks
Pseudomonadota
Bacilli
Gammaproteobacteria
Lactobacillales
Enterococcaceae
Enterobacterales
Enterobacteriaceae
Porphyromonadaceae
Erwinia
Enterococcus
Bilophila
Parabacteroides

Revision editor(s): KateRasheed, WikiWorks

Experiment 5


Reviewed Marked as Reviewed by Svetlana up on 2025-1-10

Curated date: 2025/01/08

Curator:

Revision editor(s):

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Non-Stroke Associated Pneumonia (non-SAP) subgroup in the training cohort
Group 1 name Corresponds to the case (exposed) group for case-control studies
Stroke Associated Pneumonia (SAP) subgroup in the training cohort
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Patients with acute ischemic stroke (AIS) as the subgroup in the training cohort.
Group 0 sample size Number of subjects in the control (unexposed) group
25
Group 1 sample size Number of subjects in the case (exposed) group
25

Lab analysis

Statistical Analysis

Matched on Factors on which subjects have been matched on in a case-control study
age, Matched on: "NIHSS" is not in the list (abnormal glucose tolerance, acetaldehyde, acute graft vs. host disease, acute lymphoblastic leukemia, acute myeloid leukemia, adenoma, age, AIDS, alcohol consumption measurement, alcohol drinking, ...) of allowed values.NIHSS, Matched on: "dyspagia" is not in the list (abnormal glucose tolerance, acetaldehyde, acute graft vs. host disease, acute lymphoblastic leukemia, acute myeloid leukemia, adenoma, age, AIDS, alcohol consumption measurement, alcohol drinking, ...) of allowed values.dyspagia


Signature 1

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Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Source: Fig. S4C

Description: Comparison of the microbial communities of the subset of SAP and non-SAP groups in the training cohort using Mann-Whitney

Abundance in Group 1: increased abundance in

NCBI Quality ControlLinks
Enterococcaceae
Enterococcus
Erwinia

Revision editor(s): KateRasheed, WikiWorks

Signature 2

Reviewed Marked as Reviewed by Svetlana up on 2025-1-10

Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Source: Fig. S4C

Description: Comparison of the microbial communities of the subset of SAP and non-SAP groups in the training cohort using Mann-Whitney

Abundance in Group 1: decreased abundance in

NCBI Quality ControlLinks
Roseburia

Revision editor(s): KateRasheed, WikiWorks

Experiment 6


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Curated date: 2025/01/08

Curator:

Revision editor(s):

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Non-Stroke Associated Pneumonia (non-SAP)
Group 1 name Corresponds to the case (exposed) group for case-control studies
Stroke Associated Pneumonia (non-SAP)
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Stroke Associated Pneumonia (non-SAP) refers to patients with stroke associated pneumonia (SAP)
Group 0 sample size Number of subjects in the control (unexposed) group
Not specified
Group 1 sample size Number of subjects in the case (exposed) group
Not specified

Lab analysis

Statistical Analysis

Matched on Factors on which subjects have been matched on in a case-control study
Not specified


Signature 1

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Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Source: Fig. S6A

Description: Differential abundance of taxa in stroke patients.

Abundance in Group 1: increased abundance in

NCBI Quality ControlLinks
Lactobacillus

Revision editor(s): KateRasheed, WikiWorks

Experiment 7


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Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Differences from previous experiment shown

Subjects

Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Pneumonia severity measurement Pneumonia severity measurement,pneumonia severity measurement
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Low Pneumonia Severity Index (Low-PSI)
Group 1 name Corresponds to the case (exposed) group for case-control studies
High Pneumonia Severity Index (High-PSI)
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
High Pneumonia Severity Index (High-PSI) refers to patients with severe pneumonia

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Source: Fig. S6B

Description: Differential abundance of taxa between low pneumonia severity index and high pneumonia severity index.

Abundance in Group 1: increased abundance in High Pneumonia Severity Index (High-PSI)

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Lactobacillus

Revision editor(s): KateRasheed, WikiWorks

Experiment 8


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Curated date: 2025/01/08

Curator:

Revision editor(s):

Differences from previous experiment shown

Subjects

Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Cerebrovascular disorder
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Non-Stroke Associated Pneumonia (non-SAP) Training cohort
Group 1 name Corresponds to the case (exposed) group for case-control studies
Stroke Associated Pneumonia (SAP) Training cohort
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Patients with acute ischemic stroke (AIS) as the Training cohort .
Group 0 sample size Number of subjects in the control (unexposed) group
136
Group 1 sample size Number of subjects in the case (exposed) group
52

Lab analysis

Statistical Analysis

Data transformation Data transformation applied to microbial abundance measurements prior to differential abundance testing (if any).
log transformation
Statistical test
Logistic Regression


Signature 1

Reviewed Marked as Reviewed by Svetlana up on 2025-1-10

Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Source: Table 2

Description: Relative abundance of selected microbial taxa in patients with and without SAP in the training cohort.

Abundance in Group 1: increased abundance in

NCBI Quality ControlLinks
Pseudomonadota
Bacilli
Gammaproteobacteria
Lactobacillales
Enterobacterales
Enterobacteriaceae
Enterococcaceae
Porphyromonadaceae
Erwinia
Enterococcus
Bilophila
Parabacteroides

Revision editor(s): KateRasheed, WikiWorks

Signature 2

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Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Source: Table 2

Description: Relative abundance of selected microbial taxa in patients with and without SAP in the training cohort.

Abundance in Group 1: decreased abundance in

NCBI Quality ControlLinks
Roseburia

Revision editor(s): KateRasheed, WikiWorks

Experiment 9


Reviewed Marked as Reviewed by Svetlana up on 2025-1-10

Curated date: 2025/01/08

Curator:

Revision editor(s):

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Non-Stroke Associated Pneumonia (non-SAP) validation cohort
Group 1 name Corresponds to the case (exposed) group for case-control studies
Stroke Associated Pneumonia (SAP) validation cohort
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Patients with acute ischemic stroke (AIS) as the validation cohort .
Group 0 sample size Number of subjects in the control (unexposed) group
116
Group 1 sample size Number of subjects in the case (exposed) group
28

Lab analysis

Statistical Analysis

Signature 1

Reviewed Marked as Reviewed by Svetlana up on 2025-1-10

Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Source: Table S2

Description: Relative abundance of selected microbial taxa in patients with and without SAP in the validation cohort.

Abundance in Group 1: increased abundance in

NCBI Quality ControlLinks
Pseudomonadota
Gammaproteobacteria
Bacilli
Lactobacillales
Enterobacterales
Enterobacteriaceae
Enterococcus

Revision editor(s): KateRasheed, WikiWorks

Signature 2

Reviewed Marked as Reviewed by Svetlana up on 2025-1-10

Curated date: 2025/01/08

Curator: KateRasheed

Revision editor(s): KateRasheed, WikiWorks

Source: Table S2

Description: Relative abundance of selected microbial taxa in patients with and without SAP in the validation cohort.

Abundance in Group 1: decreased abundance in

NCBI Quality ControlLinks
Roseburia

Revision editor(s): KateRasheed, WikiWorks