Exploring choices of early nutritional support for patients with sepsis based on changes in intestinal microecology

Xiao-Juan Yang; Xiao-Hong Wang; Ming-Yue Yang; Hong-Yan Ren; Hui Chen; Xiao-Ya Zhang; Qin-Fu Liu; Ge Yang; Yi Yang; Xiao-Jun Yang

doi:10.3748/wjg.v29.i13.2034

Exploring choices of early nutritional support for patients with sepsis based on changes in intestinal microecology

World J Gastroenterol. 2023 Apr 7;29(13):2034-2049. doi: 10.3748/wjg.v29.i13.2034.

Authors

Xiao-Juan Yang^{1

2}, Xiao-Hong Wang¹, Ming-Yue Yang³, Hong-Yan Ren⁴, Hui Chen⁴, Xiao-Ya Zhang¹, Qin-Fu Liu¹, Ge Yang², Yi Yang⁵, Xiao-Jun Yang⁶

Affiliations

¹ Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China.
² School of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China.
³ Department of Emergency Medicine, Affiliated Hospital of Jining Medical University, Jining 272030, Shandong Province, China.
⁴ Shanghai Mobio Biomedical Technology Co., Ltd., Shanghai 201318, China.
⁵ Department of Critical Care Medicine, Southeast University School of Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China.
⁶ Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China. yxjicu@163.com.

Abstract

Background: Sepsis exacerbates intestinal microecological disorders leading to poor prognosis. Proper modalities of nutritional support can improve nutrition, immunity, and intestinal microecology.

Aim: To identify the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology.

Methods: Thirty patients with sepsis admitted to the intensive care unit of the General Hospital of Ningxia Medical University, China, between 2019 and 2021 with indications for nutritional support, were randomly assigned to one of three different modalities of nutritional support for a total of 5 d: Total enteral nutrition (TEN group), total parenteral nutrition (TPN group), and supplemental parenteral nutrition (SPN group). Blood and stool specimens were collected before and after nutritional support, and changes in gut microbiota, short-chain fatty acids (SCFAs), and immune and nutritional indicators were detected and compared among the three groups.

Results: In comparison with before nutritional support, the three groups after nutritional support presented: (1) Differences in the gut bacteria (Enterococcus increased in the TEN group, Campylobacter decreased in the TPN group, and Dialister decreased in the SPN group; all P < 0.05); (2) different trends in SCFAs (the TEN group showed improvement except for Caproic acid, the TPN group showed improvement only for acetic and propionic acid, and the SPN group showed a decreasing trend); (3) significant improvement of the nutritional and immunological indicators in the TEN and SPN groups, while only immunoglobulin G improved in the TPN group (all P < 0.05); and (4) a significant correlation was found between the gut bacteria, SCFAs, and nutritional and immunological indicators (all P < 0.05).

Conclusion: TEN is recommended as the preferred mode of early nutritional support in sepsis based on clinical nutritional and immunological indicators, as well as changes in intestinal microecology.

Keywords: Intestinal microecology; Nutritional and immunological indicators; Nutritional support; Sepsis; Short-chain fatty acids; Supplemental parenteral nutrition; Total enteral nutrition; Total parenteral nutrition.

Publication types

Randomized Controlled Trial
Clinical Trial

MeSH terms

Enteral Nutrition
Humans
Nutritional Support*
Parenteral Nutrition
Parenteral Nutrition, Total
Sepsis* / therapy