Effect of enteral nutrition on the intestinal microbiome and risk of death in ischemic stroke patients

Background: Studies have shown that the intestinal microbiome of stroke patients is significantly altered and that the degree of microbiota disturbance correlates with prognosis. Enteral nutrition (EN) can reshape the intestinal microbiome and is important for stroke patients with dysphagia. We aimed to describe the intestinal microbiome in patients with ischemic cerebral infarction receiving standard EN.

Methods: First, 17 healthy controls (HCs), 54 stroke patients with oral feeding (ON), and 50 stroke patients with EN were matched to investigate the changes in the intestinal microbiota with EN in the first week after admission and dynamic changes in the EN group in the second week. Second, we investigated the relationship between the intestinal microbiome and clinical characteristics in a larger sample of participants receiving EN (n = 147). Survival analysis was performed using Cox proportional hazards regression. The composition and structure of the intestinal microbiota were analyzed by 16S rRNA sequencing.

Results: Compared with the HC and ON groups, patients with EN exhibited significantly different compositions of the intestinal microbiota in the first week, including enrichment of the opportunistic pathogen Enterococcus and depletion of bacteria such as Lachnospiraceae, and Ruminococcus, which were further depleted in the second week. An increase in Parvimonas and Comamonas abundances was associated with an increased risk of 180-day mortality.

Conclusions: The intestinal microbiota in ischemic stroke patients receiving EN is significantly altered, and specific strains of bacteria may be associated with prognosis and clinical indicators.