Randomized Clinical Trial
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2023; 29(13): 2034-2049
Published online Apr 7, 2023. doi: 10.3748/wjg.v29.i13.2034
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
Xiao-Juan Yang, Xiao-Hong Wang, Xiao-Ya Zhang, Qin-Fu Liu, Xiao-Jun Yang, Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
Xiao-Juan Yang, Ge Yang, School of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
Ming-Yue Yang, Department of Emergency Medicine, Affiliated Hospital of Jining Medical University, Jining 272030, Shandong Province, China
Hong-Yan Ren, Hui Chen, Shanghai Mobio Biomedical Technology Co., Ltd., Shanghai 201318, China
Yi Yang, Department of Critical Care Medicine, Southeast University School of Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Author contributions: Yang XJ was the guarantor and designed the study; Yang XJ participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Yang MY, Zhang XY, Liu QF, Yang G participated in the acquisition and the analysis of data; Wang XH, Ren HY, Chen H, Yang Y, revised the article critically for important intellectual content.
Supported by Ningxia Natural Science Foundation Project, No. 2022AAC03488; and the National Key Research and Development Program of China, No. 2016YFD0400605.
Institutional review board statement: This study was approved by the Ethics Committee of General Hospital of Ningxia Medical University, No. 2017-266.
Clinical trial registration statement: This study is registered at http://www.chictr.org.cn. The registration identification number is ChiCTR2200066641.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Yang YJ reports grants from Ningxia Natural Science Foundation Project, grants from National Key Research and Development Program of China, during the conduct of the study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the SRA database of NCBI, SRA number: PRJNA861102. Participants consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low. No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Jun Yang, PhD, Chief Physician, Department of Critical Care Medicine, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan 750004, Ningxia Hui Autonomous Region, China. yxjicu@163.com
Received: December 13, 2022
Peer-review started: December 13, 2022
First decision: January 11, 2023
Revised: January 21, 2023
Accepted: March 20, 2023
Article in press: March 20, 2023
Published online: April 7, 2023
ARTICLE HIGHLIGHTS
Research background

Sepsis is a common disease in intensive care units, with high morbidity and mortality. Our previous study confirmed the presence of gut microbiota disorders in patients with sepsis. The combination of disease and gut microbiota disorders lead to the development of multiple organ dysfunction and clinical deterioration of the patient. Nutritional support is an important part of the treatment of critically ill patients. Proper modalities of nutritional support can improve nutrition, immunity, and intestinal microecology. The exploration of early nutritional support in patients with sepsis from the perspective of intestinal microecology is important to optimize nutritional support and improve prognosis.

Research motivation

The recommendations about the choice of nutritional support modalities are largely based on expert consensus, although the level of evidence is low. Nutritional support has a significant impact on intestinal microecology; to date, the modalities of nutritional support in sepsis have not been evaluated from the perspective of intestinal microecology. This perspective can provide new insights into the optimization of the modalities for nutritional support in sepsis.

Research objectives

The main objective was to determine the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology. We applied different nutritional modalities for early and short-duration nutritional support in patients with sepsis and found differences in intestinal bacterial composition, short-chain fatty acids (SCFAs), and nutritional and immune indicators. Our results revealed for the first time that total enteral nutrition (TEN) is a good modality for early nutritional support in patients with sepsis. This study offers a new perspective for optimizing nutritional support modalities in sepsis.

Research methods

Thirty patients with sepsis who were 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 5 d, nutritional support was administered to each patient using one of the following modalities: TEN group, total parenteral nutrition (TPN group), and supplemental parenteral nutrition (SPN group). Blood and stool specimens were collected before and after nutritional support was administered, and changes in gut microbiota, SCFAs, and immune and nutritional indicators were detected and compared among the three groups.

Research results

Patients were assessed before and after the administration of nutritional support. The following differences were observed in the three groups after nutritional support: (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); (2) different trends in SCFA concentrations (increase in SCFAs in the TEN group except for caproic acid, improvement of acetic and propionic acid only in the TPN group, and decreasing trend in SCFA production in the SPN group); and (3) significant improvement in the nutritional and immunological indicators in the TEN and SPN groups, with improvement in immunoglobulin G levels only in the TPN group. Furthermore, and significant correlations were found between the gut bacteria, SCFAs, and nutritional and immunological indicators.

Research conclusions

Our results indicate that TEN is the optimal modality for early nutritional support in patients with sepsis from the perspective of intestinal microecology.

Research perspectives

Future research should focus on how different nutritional support modalities affect the structural and metabolic changes in gut microbiota composition and the underlying mechanisms. Our research group will explore these questions in a large scale clinical trial with a longer intervention time.