ORIGINAL RESEARCH article
Front. Neurosci.
Sec. Gut-Brain Axis
This article is part of the Research TopicImpact of oral and gut microbiome on health and diseasesView all 32 articles
Risk of Occult gastrointestinal bleeding with increased gut Enterococcus and Staphylococcus for poor outcomes in ischemic stroke patients
Provisionally accepted
- 1Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China
- 2Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Background: Gastrointestinal disorders are common in acute ischemic stroke (AIS) patients, but the impact of occult gastrointestinal bleeding (occult GIB) and its link to gut dysbiosis remain underexplored. Occult GIB, often undetected due to subtle symptoms, may significantly affect stroke recovery and long-term outcomes. Methods: We conducted a prospective, multi-center cohort study involving 482 AIS patients. Fecal samples collected within 48 hours of admission were analyzed using 16S rRNA gene sequencing. Patients were followed for one year to assess major adverse cardiovascular events (MACEs), including death and recurrent stroke. Results: Occult GIB was identified in 13.9% of patients, who had significantly higher rates of 90-day dependency (56.7% vs. 20.5%) and 1-year MACEs (28.6% vs. 15.5%) compared to non-GIB patients. These patients also exhibited higher infection rates and enrichment of specific gut pathogens, including Enterococcus, Staphylococcus, and Pseudomonas (all P < 0.05). Multivariate analysis revealed that elevated levels of these pathogens were independent risk factors for occult GIB. Furthermore, occult GIB independently predicted 90-day dependency (aOR 2.478, 95% CI [1.159–5.296]) and 1-year MACEs (aOR 1.905, 95% CI [1.003–3.617]). Conclusions: Occult GIB is prevalent in AIS patients and is associated with worse long-term outcomes, particularly in those with enrichment of these specific gut pathogens. Early detection and management of occult GIB may improve patient outcomes. Future research should focus on elucidating underlying mechanisms and developing targeted interventions.
Keywords: ischemic stroke, occult gastrointestinal bleeding, Gut Microbiota, major adversecardiovascular events, infection-associated pathogens
Received: 08 May 2025; Accepted: 30 Oct 2025.
Copyright: © 2025 Xia, Song, Xie, Liang and Yin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jia Yin, yinj@smu.edu.cn
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