Elevated Systemic and Intestinal Inflammatory Response Are Associated With Gut Microbiome Disorder After Cardiovascular Surgery.

Chao Wang,Jian Peng,Hongkui Wei,Xingyu Wang,Zhipeng Yang,Haini Jiang,Shengnan Yin,Xiong Xia,Jiangjin Ni

doi:10.3389/fmicb.2021.686648

Abstract

Systemic inflammatory response after cardiovascular surgery is associated with poor prognosis, to which gut barrier impairment is related. To investigate whether perioperative changes of the gut microbiome are associated with systemic and intestinal inflammatory response, we examined changes of the gut microbiome, intestinal homeostasis, and systemic inflammatory response in cardiovascular patients before (Pre) surgery and on the first defecation day [postoperative time 1 (Po1)] or a week [postoperative time 2 (Po2)] postsurgery. Markedly, the enhanced systemic inflammatory response was observed in Po1 and Po2 compared with that in Pre. In line with inflammatory response, impaired gut barrier and elevated gut local inflammation were observed in Po1 and Po2. Microbiome analysis showed a remarkable and steady decline of alpha diversity perioperatively. In addition, microbial composition in the postoperation period was characterized by significant expansion of Enterococcus along with a decrease in anaerobes (Blautia, Faecalibacterium, Bifidobacterium, Roseburia, Gemmiger, [Ruminococcus], and Coprococcus), which were typically health-associated bacteria. Spearman correlation analysis showed microbiome disorder was associated with enhanced systemic inflammatory response and intestinal dysbiosis. These results suggest that microbiome disorder was related to disturbed gut homeostatic and subsequently elevates plasma endotoxin and systemic inflammatory response after cardiovascular surgery. This study not only highlights gut microbiome would be considered in future clinical practice but also proposes a promising perspective of potential diagnostic and therapeutic options for perioperative management of cardiovascular surgery patients.

Highlights

The incidence of cardiovascular disease is increasing in recent years (Roth et al, 2017)
Through non-metric multidimensional scaling based on unweighted UniFrac distance and tested by analysis of similarities (ANOSIM), we found that the gut microbiome of patients showed significant and orderly segregation (Figure 4E)
We disclosed that the fecal microbiome of patients after cardiovascular surgery was disordered compared with the preoperative stage, and postoperative patients had increased systemic inflammatory response and imbalanced gut homeostatic

Summary

Introduction

The incidence of cardiovascular disease is increasing in recent years (Roth et al, 2017). Multiple factors, such as cardiopulmonary bypass, anesthesia, ischemia–reperfusion injury, blood transfusion, etc., could precipitate systemic inflammatory response. The elevated systemic inflammatory response is commonly attributed to postoperative complications and poor prognoses, such as prolonged hospital stays and increased mortality (Kraft et al, 2015). Previous studies had observed impaired gut barrier among patients after cardiovascular surgery, and systematic inflammation was one of the major reasons (Lau et al, 2000; Morty et al, 2008; Kano et al, 2017). It has been gradually recognized that pro-inflammatory cytokines can lead to disturbance in the intestinal barrier, causing increased tissue penetration of luminal antigens and the development of intestinal and systemic inflammation (Al-Sadi et al, 2013). Further study regarding microbiome change during the perioperative period is infrequent

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