Citation

Burmeister DM, Johnson TR, Lai Z, Scroggins S, DeRosa M, Jonas RB, Zhu C, Scherer E, Stewart RM, Schwacha MG, Jenkins DH, Eastridge BJ, Nicholson SE. J. Trauma Acute Care Surg. 2020; ePub(ePub): ePub.

Affiliation

U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas.

Copyright

(Copyright © 2020, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002612

PMID

32039976

Abstract

BACKGROUND: Traumatic injury can lead to a compromised intestinal epithelial barrier, decreased gut perfusion, and inflammation. While recent studies indicate that the gut microbiome (GM) is altered early following traumatic injury, the impact of GM changes on clinical outcomes remains unknown. Our objective of this follow-up study was to determine if the GM is associated with clinical outcomes in critically injured patients.

METHODS: We conducted a prospective, observational study in adult patients (n=67) sustaining severe injury admitted to a Level I Trauma Center. Fecal specimens were collected on admission to the Emergency Department (ED), and microbial DNA from all samples was analyzed using the QIIME pipeline and compared against the Greengenes database. Alpha and β-diversity were estimated using the observed species metrics, and analyzed with t-tests and permutational analysis of variance (PERMANOVA) for overall significance, with post-hoc pairwise analyses.

RESULTS: Our patient population consisted of 63% males with a mean age of 44 years old. 78% of the patients suffered blunt trauma with 22% undergoing penetrating injuries. The mean body mass index (BMI) was 26.9 kg/m. Significant differences in admission β-diversity were noted by hospital LOS, ICU LOS, number of days on the ventilator, infections, and ARDS (P<0.05). Beta-diversity on admission differed in patients that died compared to patients that lived (mean time to death=8 days). There were also significantly less OTUs in samples from patients who died versus those who survived. A number of species were enriched in the GM of injured patients who died, which included some traditionally probiotic species such as Akkermansia muciniphilia, Oxalobacter formigenes, and eubacterium biforme; p<0.05.

CONCLUSION: GM diversity on admission in severely injured patients is predictive of a variety of clinically important outcomes. While our study does not address causality, the GM of trauma patients may provide valuable diagnostic and therapeutic targets for the care of injured patients.

LEVEL OF EVIDENCE: Level III

Study Type: Prognostic and Epidemiological.


Keywords: Social Transition

Language: en