Integration of gut microbiota, Stroke Dysbiosis Index, and inflammatory biomarkers in assessing prognosis of acute ischemic stroke

Background: Acute ischemic stroke (AIS) is often complicated by systemic infections that worsen prognosis. Emerging evidence suggests gut microbiota dysbiosis, inflammatory biomarkers, and gut-barrier dysfunction play pivotal roles in post-stroke outcomes. This study aimed to integrate Stroke Dysbiosis Index (SDI), Microbial Dysbiosis Index (MDI), and inflammatory biomarkers to evaluate their prognostic value in AIS patients. Methods: An observational prospective cohort was conducted at a tertiary stroke center in Jakarta (September 2023-September 2024). Eighty AIS patients admitted within 24 h of onset were enrolled. Fecal samples underwent 16S rRNA sequencing for microbiota profiling and SDI/MDI calculation. Blood biomarkers (NMDAR NR2B, butyrate, TMAO, RANKL, iFABP, LPS) and platelet-to-lymphocyte ratio (PLR) were measured. Clinical severity was assessed with NIHSS. Outcomes included infection within 7 days, and complications. Statistical analyses comprised correlation, regression, and ROC curve modeling. Results: < 0.001). These markers correlated strongly with infection status. ROC analysis demonstrated promising discriminative ability in this cohort (bias-corrected AUCs > 0.80 after internal bootstrapping validation). Internal validation using 1,000 bootstrap resamples was performed to estimate optimism in AUC values and obtain bias-corrected confidence intervals. Conclusion: Gut dysbiosis, elevated dysbiosis indices, and inflammatory biomarker derangements were strongly associated with post-stroke infections and adverse prognosis. Integrating microbiota and biomarker profiles with clinical parameters may provide a robust framework for risk stratification and open avenues for microbiota-targeted therapies in AIS.