To investigate risk factors for intestinal dysbacteriosis in the early stage of sepsis and its impact on patient's prognosis.

The clinical data of 256 patients with sepsis admitted to the Department of Critical Care Medicine of the Affiliated People's Hospital of Jiangsu University from October 2017 to September 2019 were retrospectively analyzed. According to the results of fecal flora analysis and the severity of intestinal dysbacteriosis on the 7th day of admission, patients were divided into a normal intestinal flora group (control group, 75 patients), a Ⅰ disorder group (34 patients), a Ⅱ disorder group (80 patients) and a Ⅲ disorder group (67 patients). Their acute physiology and chronic health evaluation Ⅱ score, basic medical history, infection site, leukocyte count, platelet count, endotoxin level, and use of antibiotics, proton pump inhibitors and total parenteral nutrition were collected. Then risk factors for intestinal dysbacteriosis were analyzed by the multivariate Logistic regression, and a Kaplan-Meier survival curve was used to analyze the relationship between patient's intestinal dysbacteriosis and prognosis in the four groups.

The level of endotoxin [(0.15 ± 0.11), (0.14 ± 0.12), (0.24 ± 0.11), (0.26 ± 0.13) EU/mL; t = 16.317, P < 0.001], use of proton pump inhibitors [42.7% (32/75), 41.2% (14/34), 71.2% (57/80), 74.6% (50/67); χ² = 24.547, P < 0.001], use of total parenteral nutrition [5.3% (4/75), 17.6% (6/34), 33.8% (27/80), 28.4% (19/67); χ² = 20.613, P < 0.001], use of vasoactive drugs [28.0% (21/75), 26.5% (9/34), 57.5% (46/80), 50.7% (34/67); χ² = 19.181, P < 0.001] and history of diabetes mellitus [16.0% (12/75), 14.7% (5/34), 38.8% (31/80), 38.8% (26/67); χ² = 16.383, P = 0.001] of patients were statistically significantly different in the four groups. Then endotoxin, proton pump inhibitors, total parenteral nutrition, vasoactive drugs and diabetes mellitus were included in the multivariate Logistic regression analysis. The results showed that endotoxin [odds ratio (OR) = 3.749, 95% confidence interval (CI) (1.998, 7.034), P < 0.001] and diabetes mellitus [OR = 2.567, 95%CI (1.272, 5.180), P = 0.009] were independent risk factors for intestinal dysbacteriosis in sepsis patients. The 28-d cumulative survival rate of patients was statistically significantly different in the four groups (χ² = 30.088, P < 0.001). It was significantly lower in the Ⅱ and Ⅲ disorder groups than in the control group (χ² = 14.511, 31.671; both P < 0.001), and it was significantly lower in the Ⅲ disorder group than in the Ⅰ disorder group (χ² = 8.059, P = 0.005).

Endotoxin and diabetes mellitus are independent risk factors for intestinal dysbacteriosis in patients with early sepsis, and the occurrence of Ⅱ or Ⅲ degree intestinal dysbacteriosis suggests a worse prognosis.