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Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis

BACKGROUND: The human gastrointestinal tract harbours a complex multi-kingdom community known as the microbiome. Dysbiosis refers to its disruption and is reportedly extreme in acute critical illness yet its clinical implications are unresolved. The review systematically evaluates the association be...

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Autores principales: Evans, Tess, Ali, Umar, Anderton, Ryan, Raby, Edward, Manning, Laurens, Litton, Edward
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9895325/
https://www.ncbi.nlm.nih.gov/pubmed/36732439
http://dx.doi.org/10.1186/s40635-022-00486-z
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author Evans, Tess
Ali, Umar
Anderton, Ryan
Raby, Edward
Manning, Laurens
Litton, Edward
author_facet Evans, Tess
Ali, Umar
Anderton, Ryan
Raby, Edward
Manning, Laurens
Litton, Edward
author_sort Evans, Tess
collection PubMed
description BACKGROUND: The human gastrointestinal tract harbours a complex multi-kingdom community known as the microbiome. Dysbiosis refers to its disruption and is reportedly extreme in acute critical illness yet its clinical implications are unresolved. The review systematically evaluates the association between gut dysbiosis and clinical outcomes of patients early in critical illness. METHODS: Following PRISMA guidelines, a prospectively registered search was undertaken of MEDLINE and Cochrane databases for observational studies undertaking metagenomic sequencing of the lower gastrointestinal tract of critically ill adults and children within 72 h of admission. Eligible studies reported an alpha diversity metric and one or more of the primary outcome, in-hospital mortality, or secondary clinical outcomes. After aggregate data were requested, meta-analysis was performed for four studies with in-hospital mortality stratified to high or low Shannon index. RESULTS: The search identified 26 studies for systematic review and 4 had suitable data for meta-analysis. No effect of alpha diversity was seen on in-hospital mortality after binary transformation of Shannon index (odds ratio 0.52, CI 0.12–4.98, I(2) = 0.64) however certainty of evidence is low. Pathogen dominance and commensal depletion were each more frequently associated with in-hospital mortality, adverse clinical and ecological sequelae, particularly overabundance of Enterococcus. CONCLUSIONS: There is a paucity of large, rigorous observational studies in this population. Globally, alpha diversity was dynamically reduced in early ICU admission in adults and children and was not associated with in-hospital mortality. The abundance of taxa such as Enterococcus spp. appears to offer greater predictive capacity for important clinical and ecological outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40635-022-00486-z.
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spelling pubmed-98953252023-02-04 Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis Evans, Tess Ali, Umar Anderton, Ryan Raby, Edward Manning, Laurens Litton, Edward Intensive Care Med Exp Research Articles BACKGROUND: The human gastrointestinal tract harbours a complex multi-kingdom community known as the microbiome. Dysbiosis refers to its disruption and is reportedly extreme in acute critical illness yet its clinical implications are unresolved. The review systematically evaluates the association between gut dysbiosis and clinical outcomes of patients early in critical illness. METHODS: Following PRISMA guidelines, a prospectively registered search was undertaken of MEDLINE and Cochrane databases for observational studies undertaking metagenomic sequencing of the lower gastrointestinal tract of critically ill adults and children within 72 h of admission. Eligible studies reported an alpha diversity metric and one or more of the primary outcome, in-hospital mortality, or secondary clinical outcomes. After aggregate data were requested, meta-analysis was performed for four studies with in-hospital mortality stratified to high or low Shannon index. RESULTS: The search identified 26 studies for systematic review and 4 had suitable data for meta-analysis. No effect of alpha diversity was seen on in-hospital mortality after binary transformation of Shannon index (odds ratio 0.52, CI 0.12–4.98, I(2) = 0.64) however certainty of evidence is low. Pathogen dominance and commensal depletion were each more frequently associated with in-hospital mortality, adverse clinical and ecological sequelae, particularly overabundance of Enterococcus. CONCLUSIONS: There is a paucity of large, rigorous observational studies in this population. Globally, alpha diversity was dynamically reduced in early ICU admission in adults and children and was not associated with in-hospital mortality. The abundance of taxa such as Enterococcus spp. appears to offer greater predictive capacity for important clinical and ecological outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40635-022-00486-z. Springer International Publishing 2023-02-03 /pmc/articles/PMC9895325/ /pubmed/36732439 http://dx.doi.org/10.1186/s40635-022-00486-z Text en © Crown 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research Articles
Evans, Tess
Ali, Umar
Anderton, Ryan
Raby, Edward
Manning, Laurens
Litton, Edward
Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis
title Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis
title_full Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis
title_fullStr Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis
title_full_unstemmed Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis
title_short Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis
title_sort lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9895325/
https://www.ncbi.nlm.nih.gov/pubmed/36732439
http://dx.doi.org/10.1186/s40635-022-00486-z
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