Gut microbiota profiles in critically ill patients, potential biomarkers and risk variables for sepsis

Critically ill patients are physiologically unstable and recent studies indicate that the intestinal microbiota could be involved in the health decline of such patients during ICU stays. This study aims to assess the intestinal microbiota in critically ill patients with and without sepsis and to determine its impact on outcome variables, such as medical complications, ICU stay time, and mortality. A multi-center study was conducted with a total of 250 peri-rectal swabs obtained from 155 patients upon admission and during ICU stays. Intestinal microbiota was assessed by sequencing the V3-V4 hypervariable regions of the 16S rRNA gene. Linear mixed models were used to integrate microbiota data with more than 40 clinical and demographic variables to detect covariates and minimize the effect of confounding factors. We found that the microbiota of ICU patients with sepsis has an increased abundance of microbes tightly associated with inflammation, such as Parabacteroides, Fusobacterium and Bilophila species. Female sex and aging would represent an increased risk for sepsis possibly because of some of their microbiota features. We also evidenced a remarkable loss of microbial diversity, during the ICU stay. Concomitantly, we detected that the abundance of pathogenic species, such as Enterococcus spp., was differentially increased in sepsis patients who died, indicating these species as potential biomarkers for monitoring during ICU stay. We concluded that particular intestinal microbiota signatures could predict sepsis development in ICU patients. We propose potential biomarkers for evaluation in the clinical management of ICU patients.

Stool Short-Chain Fatty Acids in Critically Ill Patients with Sepsis

Objective: To determine the concentration of stool short-chain fatty acids (SCFAs) in critically ill patients with sepsis and to compare the results between the critically ill patient and the control group.Methods: This descriptive, multicenter, observational study was conducted in five health institutions. Over a 6-month study period, critically ill patients with sepsis who were admitted to the intensive care unit (ICU) and met the inclusion criteria were enrolled, and a control, paired by age and sex, was recruited for each patient. A spontaneous stool sample was collected from each participant and a gas chromatograph coupled to a mass spectrometer (Agilent 7890/MSD 5975 C) was used to measure the concentrations SCFAs.Results: The final sample included 44 patients and 45 controls. There were no differences in the age and sex distributions between the groups (p > 0.05). According to body mass index (BMI), undernutrition was more prevalent among critically ill patients, and BMI in control subjects was most frequently classified as overweight (p = 0.024). Propionic acid, acetic acid, butyric acid, and isobutyric acid concentrations were significantly lower in the critically ill patient group than in the control group (p = 0.000). No association with outcome variables (complications, ICU stay, and discharge condition) was found in the patients, and patients diagnosed with infection on ICU admission showed significant decreases in butyric and isobutyric acid concentrations with respect to other diagnostic criteria (p < 0.05).Conclusions: The results confirm significantly lower concentrations of stool SCFAs in critically ill patients with sepsis than in control subjects. Due to its role in intestinal integrity, barrier function, and anti-inflammatory effect, maintaining the concentration of SCFAs may be important in the ICU care protocols of the critical patient.

[Food intake and its relation with socioeconomic factors in an older adults group]

OBJECTIVE

To describe food intake and establish the correlation between some socioeconomic factors in a group of senior adults.

MATERIALS AND METHODS

Descriptive, cross-sectional study with 178 adults, ≥60 years old, who attended a dental consultation at Universidad de Antioquia between September 2014 and February 2015. Measurements for socio-demographic variables, frequency of food intake and food safety scale were obtained. The Chi-squared test was used to determine the association between food intake and socioeconomic variables. The categorical principal components analysis was used to determine feeding patterns.

RESULTS

About 50 % of the sample consumed dairy between one and three times a day, and meat, fruits and vegetables from one to two times. 74.7 % consumed cereals, bananas and tubers more than four times a day, which contrasts with dry grains and monounsaturated fat, whose frequency was less than once per day. Dairy and fruit intake had a significant association (p<0.05) with the following variables: economic income, stratum and food safety. Three dietary patterns known as "traditional varied diet", "unvaried" and "eating out of home" were identified, which explained the phenomenon in 12.8 %, 9.9 % and 8.4 %, respectively.

CONCLUSION

The daily consumption of food groups in the elderly could be determined by the socioeconomic condition, being better in the medium stratum, who live in safe households and receive incomes. The pattern that explained the variability of consumption in greater proportion was the traditional varied diet.