Circulating biomarkers and gut microbiota profiling predict post-stroke infection in acute ischemic stroke patientsCombined biomarkers and gut bacteria predict stroke infection risk

Frontiers in Medicine Published April 28, 2026 DOI ↗ Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain

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Key Takeaway

Consider combined biomarker and microbiota models for post-stroke infection risk stratification in acute ischemic stroke patients.

This prospective observational study assessed 80 acute ischemic stroke patients admitted within 24 h of onset at Prof. Dr. dr. Mahar Mardjono National Brain Center Hospital, Jakarta, with a 7 days follow-up period duration. The investigation focused on circulating biomarkers including NMDAR, butyrate, TMAO, RANKL, iFABP, and LPS alongside gut microbiota profiling via 16S rRNA sequencing analysis.

Post-stroke infection occurred in 37/80 patients, representing 46.3% of the cohort. NMDAR demonstrated the highest diagnostic performance with an AUC of 0.911, sensitivity of 86.5%, and specificity of 90.7. Other biomarkers included iFABP (AUC 0.894), LPS (AUC 0.896), RANKL (AUC 0.881), butyrate (AUC 0.866), and TMAO (AUC 0.865). Multivariate models integrating microbiota features and biomarkers showed improved predictive accuracy compared with single-domain approaches for the primary outcome of post-stroke infection.

Infected patients exhibited reduced evenness and dominance imbalance. Pathogenic taxa such as Escherichia coli and Salmonella enterica were enriched, while commensals like Faecalibacterium prausnitzii and Roseburia intestinalis were depleted. Safety data regarding adverse events, serious adverse events, and discontinuations were not reported in the study protocol. The study design limits causal inference and generalizability to other settings.

Practice relevance supports combined biomarker–microbiota models for risk stratification and preventive strategies. However, the single-center nature and observational design require validation in broader populations before clinical implementation can be considered.

Researchers looked at 80 patients admitted with acute ischemic stroke within 24 hours at a hospital in Jakarta. They measured various circulating biomarkers and analyzed the patients' gut microbiota to see if these signs could predict who would develop an infection after their stroke.

The study found that about 46% of the patients developed a post-stroke infection. When analyzing blood markers, one called NMDAR showed the highest ability to predict infection, while several others also performed well. Patients with infections showed changes in their gut bacteria, including a loss of beneficial microbes and a rise in harmful ones.

Models that combined both the blood markers and gut bacteria information predicted infection risk more accurately than looking at just one source of data. The researchers suggest this combined approach could help doctors identify patients at higher risk and plan preventive strategies. However, this was a small study involving only 80 people, so the results need to be confirmed in larger groups before changing standard care.

What this means for you:

Combining blood markers and gut bacteria data may better predict stroke infection risk than single tests.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundPost-stroke infection (PSI), particularly pneumonia and urinary tract infection, is a common and serious complication after acute ischemic stroke (AIS). Current diagnostic biomarkers provide limited accuracy when used in isolation. This study aimed to evaluate the diagnostic value of circulating biomarkers and gut microbiota profiling, both individually and in combination, to predict PSI in AIS patients.MethodsWe conducted a prospective observational study at Prof. Dr. dr. Mahar Mardjono National Brain Center Hospital, Jakarta. A total of 80 AIS patients admitted within 24 h of onset were enrolled and followed for 7 days to assess PSI. Blood samples were analyzed for NMDAR, butyrate, TMAO, RANKL, iFABP, and LPS. Stool samples were collected for 16S rRNA sequencing. Diagnostic performance was evaluated using ROC curves, with AUC, sensitivity, and specificity calculated. Multivariate logistic regression models were constructed to assess independent predictors and combined diagnostic accuracy.ResultsPSI occurred in 37/80 patients (46.3%). NMDAR showed the highest diagnostic performance (AUC 0.911; sensitivity 86.5%; specificity 90.7), followed by iFABP (AUC 0.894), LPS (AUC 0.896), RANKL (AUC 0.881), butyrate (AUC 0.866), and TMAO (AUC 0.865). Gut microbiota analysis revealed reduced evenness and dominance imbalance in infected patients, with enrichment of pathogenic taxa (Escherichia coli, Salmonella enterica) and depletion of SCFA-producing commensals (Faecalibacterium prausnitzii, Roseburia intestinalis). Multivariate models integrating microbiota features and biomarkers improved predictive accuracy compared with single-domain approaches.ConclusionIntegrating circulating biomarkers with gut microbiota profiling significantly enhances early prediction of PSI in AIS. These findings highlight the role of the gut–brain–immune axis in post-stroke complications and support combined biomarker–microbiota models for risk stratification and preventive strategies.

Circulating biomarkers and gut microbiota profiling predict post-stroke infection in acute ischemic stroke patientsCombined biomarkers and gut bacteria predict stroke infection risk

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Circulating biomarkers and gut microbiota profiling predict post-stroke infection in acute ischemic stroke patientsCombined biomarkers and gut bacteria predict stroke infection risk

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Clinical research that matters. Delivered to your inbox.

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