Two Patients, Same Injuries, Different Outcomes
Emergency physicians face a frustrating reality every day: two trauma patients arrive with nearly identical injuries, yet one recovers smoothly while the other spirals into organ failure. Traditional injury-severity scores cannot explain the divergence. A landmark study from the University of Colorado Anschutz Medical Campus now shows that the answer lies in the patients' blood, specifically in the thousands of proteins and metabolites that shift in the hours and days after injury.
Published in Science Translational Medicine, the research analyzed longitudinal plasma samples from more than 1,300 trauma patients and validated its findings in an independent cohort of over 300. By combining proteomics and metabolomics, a technique broadly known as multi-omics, the team identified distinct biological endotypes, molecular subtypes of the trauma response, that predict complications with 92 percent accuracy days before clinical signs emerge.
What the Blood Reveals
Senior author Mitchell Cohen, a professor of surgery at CU Anschutz, explains that the multi-omics approach captures the body's inflammatory and coagulation responses at a level of detail that no single biomarker can match. The team mapped what they call thromboinflammation endotypes, clusters of patients whose blood chemistry follows similar trajectories after injury.
Some trajectories are benign: inflammation spikes, clotting factors mobilize, and the system resolves within days. Others are not. In the high-risk endotypes, the researchers observed runaway inflammatory cascades, clotting dysregulation, and metabolic signatures associated with mitochondrial distress, all detectable in blood draws taken well before the patient showed outward signs of deterioration.
Precision Metabolic Health in Action
Co-senior author Angelo D'Alessandro, a professor of biochemistry, calls the work "precision metabolic health in action, validated in an independent cohort and ready for clinical use today." The phrase underscores a key strength of the study: the predictive model was not merely fit to one dataset but confirmed in a separate group of patients, a critical step toward clinical deployment.
The biomarker panel could be adapted to rapid point-of-care testing in emergency rooms and military field hospitals. Rather than waiting for a patient to develop organ failure and then scrambling to treat it, clinicians could intervene preemptively, adjusting fluid resuscitation, blood product ratios, or anti-inflammatory therapies based on the patient's molecular trajectory.
Why Traditional Scores Fall Short
Current trauma triage relies on anatomical injury grading, vital signs, and laboratory values such as lactate and base deficit. These measures capture the mechanical severity of injury but miss the biological response that ultimately determines outcome. Two patients with the same Injury Severity Score can harbor radically different inflammatory and coagulation profiles, and it is the biology, not the anatomy, that decides who recovers.
The multi-omics endotypes fill this gap. By mapping the full molecular landscape rather than sampling a handful of analytes, they reveal the hidden heterogeneity within what appears to be a single diagnosis: major trauma.
Funding and Next Steps
The study was supported by the National Institutes of Health and the Department of Defense, reflecting the dual interest of civilian and military medicine in improving trauma outcomes. The team, which includes co-authors Jessica Cardenas, Christopher Silliman, Anirban Banerjee, and Christopher Erickson, is now working to compress the multi-omics panel into a bedside-compatible format that delivers results within minutes rather than hours.
If successful, the technology could reshape trauma care from a reactive discipline, one that waits for complications, into a predictive one that sees them coming and acts in time.
