Trauma is a heterogeneous condition, and specific clinical phenotypes may identify target populations that could benefit from certain treatment strategies. In this retrospective study, we determined clinical phenotypes and identified new target populations of trauma patients and their treatment strategies. We retrospectively analyzed datasets from the Japan Trauma Data Bank and determined trauma death clinical phenotypes using statistical machine learning techniques and evaluation of biological profiles. The analysis included 71,038 blunt trauma patients [median age, 63 (interquartile range [IQR], 40–78) years; 45,479 (64.0%) males; median Injury Severity Score, 13 (IQR, 9–20)], and the derivation and validation cohorts included 42,780 (60.2%) and 28,258 (39.8%) patients, respectively. Of eight derived phenotypes (D-1–D-8), D-8 (n = 2178) had the highest mortality (48.6%) with characteristic severely disturbed consciousness and was further divided into four phenotypes: D-8α, multiple trauma in the young (n = 464); D-8β, head trauma with lower body temperature (n = 178); D-8γ, severe head injury in the elderly (n = 957); and D-8δ, multiple trauma, with higher predicted mortality than actual mortality (n = 579). Phenotype distributions were comparable in the validation cohort. Biological profile analysis of 90 trauma patients revealed that D-8 exhibited excessive inflammation, including enhanced acute inflammatory response, dysregulated complement activation pathways, and impaired coagulation, including downregulated coagulation and platelet degranulation pathways, compared with other phenotypes. We identified clinical phenotypes with high mortality, and the evaluation of the molecular pathogenesis underlying these clinical phenotypes suggests that lethal trauma may involve excessive inflammation and coagulation disorders.

中文翻译：

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通过创伤患者的蛋白质组学分析开发临床表型和生物学特征

创伤是一种异质性疾病，特定的临床表型可以确定可以从某些治疗策略中受益的目标人群。在这项回顾性研究中，我们确定了临床表型并确定了创伤患者的新目标人群及其治疗策略。我们回顾性分析了来自日本创伤数据库的数据集，并使用统计机器学习技术和生物学特征评估确定了创伤死亡临床表型。分析包括 71,038 名钝性创伤患者 [中位年龄，63（四分位距 [IQR]，40-78）岁；45,479 (64.0%) 名男性；中位损伤严重程度评分，13 (IQR，9-20)]，推导和验证队列分别包括 42,780 (60.2%) 和 28,258 (39.8%) 名患者。在八种衍生表型 (D-1–D-8) 中，D-8 (n = 2178) 的死亡率最高 (48.6%)，具有特征性的严重意识障碍，并进一步分为四种表型：D-8α，青年多发性创伤 (n = 464)；D-8β，体温较低的头部外伤（n = 178）；D-8γ，老年人严重颅脑损伤（n = 957）；和 D-8δ，多发性创伤，预测死亡率高于实际死亡率（n = 579）。表型分布在验证队列中具有可比性。对 90 名创伤患者的生物学特征分析显示，与其他表型相比，D-8 表现出过度炎症，包括增强的急性炎症反应、失调的补体激活途径和受损的凝血，包括下调的凝血和血小板脱粒途径。我们确定了具有高死亡率的临床表型，