Risk stratification for intestinal dysbiosis in hospitalized adult patients according to the National Dysbiosis Survey (INDIS)

The intestinal microbiota has a symbiotic relationship with the human being.Its alteration, known as dysbiosis, can result in several diseases. Some risk factors may predictthe occurrence of this condition. The purpose of this study was to evaluate the effectiveness ofthe National Dysbiosis Survey (INDIS) in the risk stratification of hospitalized adult patients thatpresented with intestinal dysbiosis. Methods: 100 patients hospitalized at the Hospital das Clínicasda UFPR were interviewed through INDIS. In this questionnaire, risk factors for dysbiosis of eachpatient were established and the dysbiosis degree was stratified in low, medium, high, and veryhigh risk. Results: Most patients were classified as medium (43%) and high risk (39%) of dysbiosis.The univariate analysis revealed an association between the degree of dysbiosis and elderlypatients (p=0.034), number of comorbidities (p<0.001), presence of diarrhea or constipation(p<0.001) and medication in use [antibiotic and/or proton pump inhibitor (PII); p<0.001]. In themultivariate analysis, the most important influence in classification was the presence of diarrheaor constipation (OR=3.00, 95% CI [1.73, 5.21] p<0.001) and medication in use (Score 3: OR =53.4, 95% CI [2.73, 1045.5], p=0.009 and Score 4-8: OR = 1709.1, 95% CI [50.27, 58103.5]p<0.001), both independent predictors of high and very high risk of dysbiosis. Conclusion: Therisk degree of intestinal dysbiosis is greater in the presence of diarrhea or constipation, the use ofantibiotics and/or PII, and in elderly patients. Once the risks of dysbiosis have been defined, INDISproved to be an effective and rapid tool for risk stratification of dysbiosis in the study population,future studies should determine the relevance of therapeutic interventions with the purpose ofnormalizing the intestinal flora.