Gut dysbiosis and stroke induced immunodepression syndrome (SIDS): The role of neutrophil to lymphocytes ratio as an early marker for sepsis in acute stroke

Vera Irawany, Retnaningsih, Rengganis Iris, Karuniawati Anis, Agustina Rina, Bardosono Saptawati, Madjid AS, Simadibrata Marcellus
Department of Neurology, School of Medicine, University of Diponegoro / dr. Kariadi Hospital Semarang, Indonesia

Sepsis is a leading cause of death in critical care patient. Early recognition of sepsis in high risk to infection patient is the key of prompt and early treatment. But it become challenging in ‘no SIRS’ septic patient due to immunodepression, when classical infection signs and symptoms are subtle.   In recent study shows that in acute stroke, the inflammation process will lead to an anti inflammatory state which known as stroke induced immunodepression syndrome (SIDS), a condition that put stroke patient prone to severe infection. The anti inflammatory state were driven by gut. As we know gut is the motor of critical illness, more than 70% of immune system were develop in GALT (gut associated lymphoid tissue) system and gut microbiota has a mayor role in immune and metabolism homeostasis. So, gut dysbiosis may have a huge contribution in immune dysregulation.

In this study we will profiling gut dysbiosis in all acute stroke that were admitted to ICU by sequencing fecal bacteria (16 rRNA using amplicon new gene sequencing technique) and follow the trend of neutrophil to lymphocyte ratio (NTLR) at d1,d3 and d5 whether it became sepsis or not in day 5 (using SOFA score and procalcitonin). We also check HLA-DR and IL-17 at d3, to confirm immunodepression state in acute stroke. Using statistic analysis, we will determine the profile of gut dysbiosis and cut off of NTLR in early state to predict sepsis in acute stroke.

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