Casual Relationship between the GUT Microbiota Dysbiosis, Intestinal Motility, and Development of Protein-Energy Malnutrition in Patients in a Chronic Critical State after Severe Brain Damage

Protein-energy malnutrition (PEM) remains one of the most pressing issues in patients with severe traumatic brain injury in intensive care units (ICUs), as it is highly prevalent, difficult to manage, and its causes are not fully understood.
The aim of the study was to assess the influence of gut microbial imbalance and gastrointestinal motility on the development of malnutrition in patients in a chronic critical state and severe brain damage.
Materials and methods. A single-center prospective observational study included 31 patients (median age 52 years; 68% males) aged 18–74 years with traumatic brain injury or stroke requiring ICU stay for more than 5 days and enteral tube feeding. Patients with diabetes mellitus, acute multiple organ failure (MOF), shock, implanted devices, or tracheoesophageal fistula were excluded. Nutritional status was assessed at baseline and on Day 20 using the Russian malnutrition scale and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Additionally, clinical outcomes, anthropometric data, gastrointestinal biomarkers, gut microbiota composition, electrogastroenterography (EGEG) and functional scales parameters were recorded.
Results. Moderate and severe malnutrition according to the GLIM criteria was found at baseline in 29.1% of patients, and in 27.7% of patients on Day 20 (p = 0.9), while according to the Russian scale these numbers were 61.3% and 78.6%, respectively (p = 0.8). Dynamics of clinical scales, functional indicators, and gastrointestinal biomarkers during the follow-up revealed no clinically significant changes. Significant and persistent deviations 2 from reference values in gut microbiota composition (decrease in the content of E. coli, p = 0.026; increase in Enterobacter spp., p = 0.020) and EGEG parameters were recorded at both evaluation time-points. Identified PEM was also associated with impaired gastrointestinal motility.
Conclusion. The data indicate a statistically significant relationship between PEM, changes in the gut microbiota and gastrointestinal motility, which confirms the important role of these factors in PEM pathogenesis in patients with severe brain damage in a chronic critical state.

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