gms | German Medical Science

Objectives: It is widely accepted that major trauma leads to systematic dysregulation with concomitant metabolic derangement. While metabolomics measurements are already used in other medical fields such as oncology, we still know little about the specific effects of trauma on human metabolism. The impetus for our study was to identify relevant components of the metabolic pathway in the existing literature.

Methods: A systematic literature search of MEDLINE and Embase from 2000 to 2022 was performed. Original publications reporting metabolomics measurements after severe trauma in human studies were included. All significant parameters were extracted and evaluated using a reductive procedure. The metabolites were stratified according to their time point of measurement to either group: acute (baseline/0h after trauma), intermediate (6–24 h after trauma) or late (>24 h–7 days). The metabolites were arranged according to their functional pathways and their role in the metabolism.

Results and conclusion: A total of 3,878 publications were identified in the databases. Nine publications met our criteria and were included in the systematic review. Most metabolites were reported for the acute phase. In the acute phase, metabolites that are involved in the energy providing pathways (TCA, glycolysis, ketolysis), detoxification and excretion (urea cycle, antioxidant synthesis) as well as biosynthesis (choline-oxidation-pathway) are significantly elevated. In the intermediate phase, a decrease of the urea cycle activity was detected. In the late phase, there is a less consistent metabolic pattern visible with partial in- and decrease of the prior mentioned pathways. Overall, ornithine, succinate and lactate were the most frequently reported metabolites in the literature severe trauma.

There is great heterogeneity in the existing literature between study designs, groups and time-points when it comes to metabolomics research. As far as these discrepancies allow, a specific metabolic dysregulation can be observed, with a particular impact on energy-providing and detoxification/excretion pathways with a time-dependent dynamic. Especially in the acute phase after trauma, a highly catabolic metabolism with increased oxidative stress is visible indicating increased energy requirements of the patients' organism. Identified metabolites and pathways may be of particular interest for future research.