Early Metabolic Trajectory Identifies High-Risk Normotensive Trauma Patients

Occult shock, defined as normotension with metabolic derangement, has been associated with adverse outcomes in trauma patients. However, the clinical significance of early metabolic trajectory within this population remains unclear.

We conducted a retrospective cohort study of adult trauma patients with occult shock (systolic blood pressure ≥90 mmHg and lactate >2 mmol/L). Patients with available serial base deficit measurements were included and categorized into four groups based on early metabolic trajectory: no severe deficit, recovered severe deficit, developed severe deficit, and persistent severe deficit. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit utilization and transfusion requirements. Multivariable logistic regression analysis was performed adjusting for age, injury severity score, Glasgow Coma Scale, and sex.

A total of 898 patients were included. In-hospital mortality differed significantly across trajectory groups (3.6% no deficit, 2.2% recovered, 12.0% developed, and 18.6% persistent; P < 0.001). Persistent severe deficit was independently associated with increased mortality (adjusted odds ratio 3.03; 95% confidence interval, 1.50-6.15; P = 0.002), whereas recovered severe deficit was not associated with increased risk (adjusted odds ratio, 0.54; 95% confidence interval, 0.14-2.01; P = 0.357). Resource utilization, including intensive care unit length of stay and transfusion requirements, increased progressively across trajectory groups.

Among trauma patients with occult shock, early metabolic trajectory provides important prognostic information. Persistent metabolic derangement identifies a high-risk subgroup, whereas recovery of metabolic abnormalities is associated with favorable outcomes. Dynamic assessment of metabolic response may improve risk stratification beyond initial measurements.