Alterations of the host-lung microbiome metasystem in systemic inflammatory response syndrome is associated with secondary pneumonia.

Host-respiratory microbiome interplay is vital to lung homeostasis. Systemic inflammatory response syndrome (SIRS) is an intense alteration in host status that necessitates rapid microbiome adaptation to avoid respiratory complications. Using longitudinal multi-omic data from patients with SIRS, we confirm that the respiratory microbiome, blood metabolome, and immune cells form a dynamic metasystem and define a metacluster with distinct T/B cell trafficking, anaerobic bacteria, high tyrosine metabolism, and low fatty acid biosynthesis. This metacluster status can serve to classify the severity of alterations in host-lung microbiome interactions as moderate or severe and to predict pneumonia and mortality. We demonstrate the robustness of these findings in an independent, randomized controlled trial and propose that interferon-γ treatment may benefit patients with severe metacluster alterations but harm those with moderate alterations. Our study supports the concept of the host-respiratory microbiome as a dynamic metasystem, in which specific alterations are associated with pneumonia and responses to interferon-γ treatment.