TY - JOUR
T1 - The gut microbiome distinguishes mortality in trauma patients upon admission to the emergency department
AU - Burmeister, David M.
AU - Johnson, Taylor R.
AU - Lai, Zhao
AU - Scroggins, Shannon R.
AU - Derosa, Mark
AU - Jonas, Rachelle B.
AU - Zhu, Caroline
AU - Scherer, Elizabeth
AU - Stewart, Ronald M.
AU - Schwacha, Martin G.
AU - Jenkins, Donald H.
AU - Eastridge, Brian J.
AU - Nicholson, Susannah E.
N1 - Funding Information:
The authors would like to thank the following individuals for their support: Basil A. Pruitt, Jr., Dawn Garcia, and Korri S. Weldon for 16S sequencing sample processing and data generation. This work was funded by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant KL2 TR001118. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of the Army and the Department of Defense. Support was also received by the University of Texas Health San Antonio Military Health Institute and the Bob Kelso Endowment awarded to the University of Texas Health San Antonio Department of Surgery.
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - 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, and microbial DNA from all samples was analyzed using the Quantitative Insights Into Microbial Ecology pipeline and compared against the Greengenes database. α-Diversity and β-diversity were estimated using the observed species metrics and analyzed with t tests and permutational analysis of variance for overall significance, with post hoc pairwise analyses. RESULTS Our patient population consisted of 63% males with a mean age of 44 years. Seventy-eight percent of the patients suffered blunt trauma with 22% undergoing penetrating injuries. The mean body mass index was 26.9 kg/m2. Significant differences in admission β-diversity were noted by hospital length of stay, intensive care unit hospital length of stay, number of days on the ventilator, infections, and acute respiratory distress syndrome (p < 0.05). β-Diversity on admission differed in patients who died compared with patients who lived (mean time to death, 8 days). There were also significantly less operational taxonomic units 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 Gut microbiome 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 Prognostic and epidemiological, level III.
AB - 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, and microbial DNA from all samples was analyzed using the Quantitative Insights Into Microbial Ecology pipeline and compared against the Greengenes database. α-Diversity and β-diversity were estimated using the observed species metrics and analyzed with t tests and permutational analysis of variance for overall significance, with post hoc pairwise analyses. RESULTS Our patient population consisted of 63% males with a mean age of 44 years. Seventy-eight percent of the patients suffered blunt trauma with 22% undergoing penetrating injuries. The mean body mass index was 26.9 kg/m2. Significant differences in admission β-diversity were noted by hospital length of stay, intensive care unit hospital length of stay, number of days on the ventilator, infections, and acute respiratory distress syndrome (p < 0.05). β-Diversity on admission differed in patients who died compared with patients who lived (mean time to death, 8 days). There were also significantly less operational taxonomic units 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 Gut microbiome 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 Prognostic and epidemiological, level III.
KW - Trauma
KW - clinical outcomes
KW - dysbiosis
KW - gut microbiome
KW - injury
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U2 - 10.1097/TA.0000000000002612
DO - 10.1097/TA.0000000000002612
M3 - Article
C2 - 32039976
AN - SCOPUS:85083914156
SN - 2163-0755
VL - 88
SP - 579
EP - 587
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 5
ER -