The gut microbiota-gut-brain axis in sepsis-associated encephalopathy: pathogenesis and therapeutic potential of probiotics

Sepsis-associated encephalopathy (SAE) represents one of the most severe complications of sepsis, characterized by diffuse neurological dysfunction. It significantly increases patient mortality and can lead to long-term neuropsychiatric sequelae, including cognitive deficits, anxiety, and depression, thereby imposing a substantial societal burden. Currently, the clinical diagnosis of SAE relies primarily on subjective assessment scales, and effective specific therapies are lacking, underscoring the need for further elucidation of its pathological mechanisms. Recent studies indicate that gut dysbiosis plays a pivotal role in the development of SAE. Consequently, probiotic-based microbiome intervention strategies offer a novel approach to SAE prevention and treatment by reshaping the gut microbiota, restoring beneficial metabolite levels, and inhibiting harmful immune cell migration. This review aims to systematically summarize the latest mechanistic studies on the gut microbiota-gut-brain axis in SAE. It focuses on evaluating the experimental evidence and potential clinical value of microbiological therapies, particularly probiotics, while outlining future challenges and translational research directions in this field. The goal is to provide a theoretical basis for developing precise intervention strategies for SAE.