Molecular and Biomarker Signatures of Trauma: The State of Precision Medicine

Resuscitation and prognostication of patients after traumatic injury rely primarily on broad clinical and laboratory measures that may overlook subclinical microcirculatory and metabolic derangements. Emerging data show that individual responses to injury are heterogeneous, and characterizing such responses using biomarkers is a growing priority. Recent literature has increasingly explored the use of high-throughput "-omics" methodologies to define biologic patterns after injury. This review summarizes existing literature on blood-based biomarkers after traumatic injury to describe the emerging role of -omics in trauma precision medicine.

We conducted a literature review using PubMed, focusing on studies using multiplex or "-omics" techniques (including metabolomics, proteomics, and transcriptomics) to identify biomarkers in injured patients. Articles detailing reviews, isolated brain injury, pediatric populations, or animal studies were excluded.

Our search yielded 888 articles, of which 28 met the inclusion criteria. Across the included studies -omics patterns were broadly grouped into five clinical categories: temporality (54%), severity (29%), mortality (18%), organ dysfunction (39%), and other complications (61%). Most studies described trends in inflammation (71%), while 21% described endothelial damage and 29% delineated specific endotypic reactions to injury. Complement activation and inflammatory cytokines (i.e., interleukin (IL)-6, IL-8, IL-10, granulocyte colony-stimulating factor, and monocyte chemoattractant protein 1) increased with injury severity, while coagulation factors decreased.

Blood-based biomarkers identified via -omics may help characterize distinct hemostatic, endothelial, metabolic, and immune responses to traumatic injury. However, most currently available data remain exploratory and associative rather than clinically actionable. Larger prospective studies are needed to discern between injury/hemorrhage versus resuscitation responses. If identified, these markers may prognosticate and risk stratify clinical courses to identify potential complications and guide resuscitation.