Gut fungal signatures predict disease status in acute ischemic stroke

The role of gut fungi in acute ischemic stroke (AIS) remains poorly understood. To characterize the gut mycobiome in AIS and explore its association with disease severity and prognosis. We profiled the gut mycobiome of an AIS cohort (<i>n</i> = 117) with longitudinal disease estimation via ITS2 sequencing. The gut mycobiome of patients with AIS differed significantly from that of healthy individuals, featured by shift of enterotypes, marked alterations of core genera such as <i>Aspergillus</i>, <i>Candida</i>, and <i>Geotrichum</i>. AIS exhibited stronger interkingdom correlations and higher node degrees in the co-occurrence network. Random Forest classifiers, based on features marked by <i>Geotrichum</i> and yeast, were effective to distinguish patients with AIS from healthy controls (AUC = 0.95) and predicting disease severity (AUC = 0.955) in the cross-sectional data, and reliably indicated AIS outcomes in a prospective data (AUC = 0.775). These findings suggest that gut fungi may have potential as predictors of AIS status and prognosis.