1.Clinical factors associated with composition of lung microbiota and important taxa predicting clinical prognosis in patients with severe community-acquired pneumonia.
Sisi DU ; Xiaojing WU ; Binbin LI ; Yimin WANG ; Lianhan SHANG ; Xu HUANG ; Yudi XIA ; Donghao YU ; Naicong LU ; Zhibo LIU ; Chunlei WANG ; Xinmeng LIU ; Zhujia XIONG ; Xiaohui ZOU ; Binghuai LU ; Yingmei LIU ; Qingyuan ZHAN ; Bin CAO
Frontiers of Medicine 2022;16(3):389-402
Few studies have described the key features and prognostic roles of lung microbiota in patients with severe community-acquired pneumonia (SCAP). We prospectively enrolled consecutive SCAP patients admitted to ICU. Bronchoscopy was performed at bedside within 48 h of ICU admission, and 16S rRNA gene sequencing was applied to the collected bronchoalveolar lavage fluid. The primary outcome was clinical improvements defined as a decrease of 2 categories and above on a 7-category ordinal scale within 14 days following bronchoscopy. Sixty-seven patients were included. Multivariable permutational multivariate analysis of variance found that positive bacteria lab test results had the strongest independent association with lung microbiota (R2 = 0.033; P = 0.018), followed by acute kidney injury (AKI; R2 = 0.032; P = 0.011) and plasma MIP-1β level (R2 = 0.027; P = 0.044). Random forest identified that the families Prevotellaceae, Moraxellaceae, and Staphylococcaceae were the biomarkers related to the positive bacteria lab test results. Multivariable Cox regression showed that the increase in α-diversity and the abundance of the families Prevotellaceae and Actinomycetaceae were associated with clinical improvements. The positive bacteria lab test results, AKI, and plasma MIP-1β level were associated with patients' lung microbiota composition on ICU admission. The families Prevotellaceae and Actinomycetaceae on admission predicted clinical improvements.
Acute Kidney Injury/complications*
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Bacteria/classification*
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Chemokine CCL4/blood*
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Community-Acquired Infections/microbiology*
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Humans
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Lung
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Microbiota/genetics*
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Pneumonia, Bacterial/diagnosis*
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Prognosis
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RNA, Ribosomal, 16S/genetics*
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