A Component Analysis of Endotheliopathy of Trauma

Endotheliopathy of trauma (EOT) is a complex response to severe injury involving coagulopathy, platelet dysfunction, endothelial dysfunction, and shock. Although EOT is associated with poor outcomes, the relative contribution of each component is not well defined. This study aimed to determine the impact of individual EOT components on mortality and multiple organ failure (MOF) in severely injured patients. We conducted a single-center prospective observational study from 2022 to 2024 including patients presenting within two hours of injury as a Level 1 trauma activation or with hemorrhage. Demographics, clinical data, and outcomes were collected. Admission blood samples were analyzed for ten biomarkers using a Luminex assay. The primary endpoint was a composite of in-hospital mortality or MOF. Twenty clinical and biomarker variables were grouped into four EOT components. Component-specific multivariable models were developed using ridge regression, and performance was assessed by area under the curve (AUC). Among 159 patients, median age was 39 years, 80% were male, and 42% had penetrating injuries. Median Injury Severity Score was 19, with 15.7% meeting the primary outcome. All component models showed similar predictive performance, highlighting the multifactorial nature of EOT and supporting the need for comprehensive treatment strategies.