An observational cohort study of factors associated with patients' reports of being offered lumbar spine surgery during orthopaedic spine consultations for chronic low back pain.

Sepsis is a life-threatening syndrome caused by a dysregulated host response to infection and remains a leading cause of organ dysfunction and death worldwide (). Although sepsis imposes a major clinical burden, treatment remains dominated by timely infection control, antimicrobial therapy, and organ support, with few interventions that directly modify the underlying host response (). For this reason, mechanisms that shape the host response have become important therapeutic targets beyond pathogen control and organ support. The gut microbiota may contribute to the marked heterogeneity of sepsis progression and organ injury. Sepsis is frequently accompanied by profound gut microbiota dysbiosis, which may further aggravate disease progression, while sepsis itself exacerbates disruption of intestinal microbial homeostasis (). Preclinical and clinical studies suggest that gut microbiota dysregulation is involved in sepsis-associated organ injury, including hepatic, renal, and other extraintestinal complications. These findings link the gut microbiota to both sepsis mechanisms and potential therapeutic strategies. This review integrates gut dysbiosis, microbial product translocation, microbial metabolites, and host–microbe interactions into a gut-organ axis framework to explain how intestinal microbial disruption may contribute to sepsis progression and organ injury. However, the causal direction of this relationship remains difficult to establish in human sepsis because microbiota alterations are strongly influenced by antibiotics, nutrition, immune status, and organ support (). Therefore, this review distinguishes between causal-supporting experimental evidence, associative human evidence, and biologically plausible but still speculative mechanisms. To improve transparency in literature selection, we conducted a structured literature search to identify studies relevant to gut microbiota dysbiosis, sepsis pathogenesis, sepsis-associated organ injury, and microbiota-targeted therapeutic strategies. PubMed and Web of Science were searched for English-language publications. The main search covered studies published up to December 2025.