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Observational Study
. 2020 May;88(5):579-587.
doi: 10.1097/TA.0000000000002612.

The gut microbiome distinguishes mortality in trauma patients upon admission to the emergency department

David M Burmeister  1 , Taylor R Johnson, Zhao Lai, Shannon R Scroggins, Mark DeRosa, Rachelle B Jonas, Caroline Zhu, Elizabeth Scherer, Ronald M Stewart, Martin G Schwacha, Donald H Jenkins, Brian J Eastridge, Susannah E Nicholson
Affiliations
Observational Study

The gut microbiome distinguishes mortality in trauma patients upon admission to the emergency department

David M Burmeister et al. J Trauma Acute Care Surg. 2020 May.

Abstract

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/m. 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.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to disclose.

Conflicts of Interest:

No competing financial interests exist.

Figures

Figure 1.
Figure 1.
Operational Taxonomic Units (OTUs) demonstrating alpha diversity for chosen patient characteristics. Statistical analyses reveal that OTUs increase with age (A) and in patients who died (B). *p < 0.05.
Figure 2.
Figure 2.
Significant findings in beta diversity measures for chosen patient characteristics. Bray Curtis measures clustered different depending on BMI (A), while the weighted Unifrac clustered patients based upon their hospital length of stay (B). The Jaccard similarity index was able to significantly cluster patients based on whether they experienced acute respiratory distress syndrome (C), Gender (D), ventilator days (E), and ICU LOS (F). p < 0.05 for all plots.
Figure 3.
Figure 3.
Beta diversity plots for mortality. Patients that lived showed significantly different β-diversity than those that died for all β-diversity measures: Bray Curtis (A), Jaccard (B), Unweighted UNIFRAC (C), and weighted UNIFRAC (D). p < 0.05 for all plots.
Figure 4.
Figure 4.
Phylogenetic differences associated with survival. (A) At the phylum level, levels of Bacteroidetes was unchanged, while levels of Firmicutes was significantly enriched in patients that died versus those that did not. (B) At the species level, there were 4 specific species (Eubacterium biforme, Ruminococcus flavefaciens, Akkermansia muciniphila, and Oxalobacter formigenes) that were enriched in the gut microbiota of patients that died versus those that did not (P<0.05).
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