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.