Abstract
The novel conceptual disease model, the oral–gut axis, which represents the immunomodulatory mutual relationship between oral and gut microbial compartments, has been attracting attention in relation to systemic health issues. We investigated whether this unique crosstalk influences the systemic condition of patients with COVID-19 infections who received extracorporeal membrane oxygenation (ECMO) in the intensive care unit (ICU) during April and December 2020. In this case-control study, patients were divided into two groups according to their survival (total entry size, n = 21; survivors, n = 13; non-survivors, n = 8). Patients were evaluated using the oral assessment guide from Fukuoka University (OAG-F) and the Bristol Stool Form Scale (BSFS) to examine the oral and fecal conditions. A blood-based inflammatory factor, the neutrophil-to-lymphocyte ratio (NLR), was used as an indicator of systemic immunity. The high total OAG-F scores were associated with both elevated BSFS and NLR values, and a mutually positive correlation between BSFS and NLR was observed. This indicated an interplay between oral deterioration, gut dysbiosis, and the impairment of immunity. Furthermore, oral deterioration was more frequently observed in non-survivors on day 14 of ICU admission. In addition, on days 7 and 21 of ICU admission, impaired immunity, reflected by an elevated NLR, was observed in non-survivors. However, the distribution of the gut microbiome—reflected by increased BSFS values—with the time it was examined was not directly observed in non-survivors. Taken together, these findings suggested that oral–gut health may be specifically associated with mortality in COVID-19 patients receiving ECMO in the ICU.
Highlights
The connected anatomy beginning at the oral cavity and ending at the gut composes the gastrointestinal tract as the digestive system, and distinctive microbiota are harbored along this tract
Of note, increased oral-to-gut microbial transmission is observed in several diseases, including rheumatoid arthritis [27] and colorectal cancer [12], in comparison to healthy individuals, and the increased presence of specific oral bacteria in the intestine has been reported to contribute to the progression of these diseases [28]
The present findings suggest that it is plausible that the oral–gut axis, across the two major organs, affects the immunocompromised host and mortality rates in severe
Summary
On the appearance of inflammation in the subgingival pockets, periodontopathogens can invade the ulcerated sulcular epithelium and can disseminate into the systemic circulation. Dysbiotic oral microbiota may translocate to the respiratory/gastrointestinal tracts, reducing diversity and causing a shift in the bacterial composition of these distal organs, leading to an impairment of physiological systemic homeostasis, primarily in metabolism and in immunity. This theory has recently received increased attention as a novel conceptual disease model: the oral–gut axis [6,7,8,9]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
