{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T16:35:11Z","timestamp":1793637311532,"version":"4.5.1"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute ischemic stroke (AIS) is often complicated by systemic infections that worsen prognosis. Emerging evidence suggests gut microbiota dysbiosis, inflammatory biomarkers, and gut\u2013barrier 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An observational prospective cohort was conducted at a tertiary stroke center in Jakarta (September 2023\u2013September 2024). Eighty AIS patients admitted within 24\u202fh 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\u202fdays, and complications. Statistical analyses comprised correlation, regression, and ROC curve modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Infection occurred in 46.3% of patients, predominantly older (&amp;gt;60\u202fyears) and female. Infected patients showed reduced microbial diversity, enrichment of pathogenic taxa (Klebsiella, Escherichia, Salmonella), elevated SDI\/MDI, and depleted SCFA producers. Biomarkers revealed increased NMDAR, TMAO, iFABP, and LPS, with reduced butyrate and RANKL (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). These markers correlated strongly with infection status. ROC analysis demonstrated promising discriminative ability in this cohort (bias-corrected AUCs &amp;gt; 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1707253","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T13:08:46Z","timestamp":1770037726000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Integration of gut microbiota, Stroke Dysbiosis Index, and inflammatory biomarkers in assessing prognosis of acute ischemic stroke"],"prefix":"10.3389","volume":"12","author":[{"given":"Weny","family":"Rinawati","sequence":"first","affiliation":[{"name":"Doctoral Program in Medical Science, Faculty of Medicine, Universitas Airlangga","place":["Surabaya, Indonesia"]},{"name":"Department of Supporting Medicine, National Brain Center Hospital Mahar Mardjono","place":["Jakarta, Indonesia"]},{"name":"Laboratory and Blood Bank Unit, National Brain Center Hospital Mahar Mardjono","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aryati","family":"Aryati","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga","place":["Surabaya, Indonesia"]},{"name":"Dr. Soetomo General Academic Hospital","place":["Surabaya, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulloh","family":"Machin","sequence":"additional","affiliation":[{"name":"Dr. Soetomo General Academic Hospital","place":["Surabaya, Indonesia"]},{"name":"Department of Neurology, Faculty of Medicine, Universitas Airlangga","place":["Surabaya, Indonesia"]},{"name":"Airlangga University Hospital","place":["Surabaya, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Kiechl","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck","place":["Innsbruck, Austria"]},{"name":"VASCage - Center for Clinical Stroke Research","place":["Innsbruck, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Broessner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck","place":["Innsbruck, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"598","DOI":"10.3389\/fneur.2020.00598","article-title":"Gut microbiota in acute ischemic stroke: from pathophysiology to therapeutic implications","author":"Battaglini","year":"2020","journal-title":"Front 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