A pilot study on hemodynamically stable isolated chest trauma patients reveals dysregulation of oxidative metabolism.

Background: Metabolomic dysregulation precedes clinical deterioration following injury. However, despite receiving comparable treatment, patients with similar injury severity often follow different clinical trajectories and outcomes.

Methods: This prospective cohort study at a level 1 trauma centre screened 4541 acutely injured patients with chest trauma between September 2019 and February 2023. Fifty hemodynamically stable patients with isolated chest trauma were recruited for the final analysis. Urine samples were collected on the injury days 1, 3, and 7. For healthy subjects, the urine sample was collected once. NMR-based metabolomics was performed.

Results: The study found that the majority of injured patients were young (median age of 40 years), with road traffic injuries being the most common. The median time to presentation of the patient to the ED was 3.08 h, and 92% of patients had multiple rib fractures, pulmonary contusion (60%), and pleural involvement (88%). No patient died. The study found that twenty metabolites were dysregulated (p-value < 0.001). Twelve metabolites were upregulated, while the other eight showed downregulation. However, only five metabolites showed temporal association. 4-HPA, phenylalanine, aconitate, and carnitine represent a high potential for use as a biomarker in patients with isolated blunt trauma chest patients who remain hemodynamically stable. These differentially regulated metabolites were involved in Glyoxylate and dicarboxylate metabolism pathways, glycine, serine, and threonine metabolism, and the Citrate cycle (TCA cycle).

Conclusions and relevance: Metabolomics can accurately characterize metabolism in isolated blunt chest trauma patients, revealing perturbed pathways of traits such as oxidative stress and amino acid metabolisms. These metabolites could serve as biomarkers to detect systemic changes following chest injuries early. Metabolic profiling following an injury can aid in detecting systemic changes early and identifying novel biomarkers, enabling targeted interventions to improve patient outcomes.