The following is a summary of “Metabolomic in severe traumatic brain injury: exploring primary, secondary injuries, diagnosis, and severity,” published in the January 2025 issue of Critical Care by Banoei et al.
Traumatic brain injury (TBI), particularly severe traumatic brain injury (sTBI), has been a significant global public health concern due to its high rates of injury-related death and disability, with severe cases accounting for only 10% of all TBI cases but resulting in a substantial mortality rate of 30-40% and significant long-term disabilities among survivors.
Researchers conducted a retrospective study to explore the potential of metabolomics in diagnosing sTBI and examining primary and secondary brain injury.
They analyzed serum samples from 59 adult patients with sTBI and 35 age- and sex-matched orthopedic injury controls using quantitative metabolomics, including proton nuclear magnetic resonance (1H-NMR) and direct infusion/liquid chromatography-tandem mass spectrometry (DI/LC–MS/MS). Metabolites were identified and quantified on days 1 and 4 post-injury. Advanced analytical methods were employed to identify metabo-patterns associated with sTBI diagnosis and primary and secondary brain injury.
The results showed distinct serum metabolic profiles between sTBI and orthopedic injury (OI) controls, with significant changes in metabolites on days 1 and 4 post-injury. The number and extent of altered metabolites were more effective on day 4, indicating the progression from primary to secondary brain injury. High sensitivity and specificity were observed in distinguishing sTBI from OI controls. Energy-related metabolites, including glucose, pyruvate, lactate, mannose, and polyamine metabolism markers (spermine and putrescine), along with acylcarnitines and sphingomyelins, were elevated on day 1. On day 4, neurotransmission-related metabolites like glutamate, phenylalanine, tyrosine, and branched-chain amino acids (BCAAs) increased more significantly. Additionally, multiple metabolites, such as acylcarnitines (ACs), lysophosphatidylcholines (LysoPCs), glutamate, and phenylalanine, correlated with injury severity on day 4, while lactate, glucose, and pyruvate were linked to injury severity on day 1.
Investigators concluded the serum metabolomics showed diagnostic potential for sTBI and could reflect molecular mechanisms of primary and secondary brain injuries.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05258-1
