Abstract
OBJECTIVE: To explore associations between gut microbiota composition, blood/urine biochemical markers, and recurrent calcium oxalate stones, identifying potential risk factors. METHODS: A retrospective study compared 88 patients (≥2 stone episodes, 2023-2025) with 90 age/gender-matched controls. Fecal 16S rRNA sequencing assessed microbial diversity, alongside blood lipid profiles, creatinine, uric acid, and 24-hour urine analysis. Multivariate logistic regression identified independent predictors. RESULTS: Baseline demographics were comparable (P > 0.05). Patients exhibited higher Escherichia coli and Fusobacterium, lower Faecalibacterium and Lachnospira (P < 0.05). Elevated triglycerides, creatinine, reduced HDL-C, and lower urinary magnesium/citrate (P < 0.05) were observed. Spearman analysis linked E. coli abundance to higher creatinine (r = 0.598) and lower HDL-C (r = -0.607), while Faecalibacterium inversely correlated with creatinine (r = -0.624; all P < 0.05). Logistic regression identified E. coli abundance, serum creatinine, and urinary magnesium as independent recurrence risk factors (P < 0.05). CONCLUSION: Gut microbiota dysbiosis correlates with metabolic and urinary abnormalities in recurrent stone formers. Monitoring E. coli levels and biochemical parameters may aid recurrence prediction.