Serum sRAGE, CC16, and Syndecan-1 as Predictors of ARDS and Mortality After Severe Chest Trauma

Inclusion criteria

• Adult patients aged 18 - 60 years old.

• Patients with blunt or penetrating severe chest trauma.
• Chest Abbreviated Injury Scale (Chest AIS ≥3).
• Admission within 24 hours of injury.
• Patients admitted to the Trauma Unit or Trauma ICU.
• Written informed consent obtained from the patient or legally authorized representative.

Exclusion criteria

• h. Age below 18 years or above 60 years old (to ensure a homogeneous adult study population and avoid age- related physiological differences).

• i. Hospital admission more than 24 hours after injury (to ensure early biomarker measurement before secondary inflammatory changes occur).
• j. Previous diagnosis of acute respiratory distress syndrome before admission (to ensure that ARDS outcomes are attributable to the index chest trauma).
• k. Pre-existing chronic interstitial lung disease (to avoid baseline pulmonary abnormalities that may influence biomarker levels and respiratory outcomes).
• l. Acute exacerbation of chronic obstructive pulmonary disease requiring hospitalization (to minimize confounding from pre-existing acute pulmonary inflammation).
• m. Active pulmonary infection before trauma (to exclude pre-existing pulmonary inflammation that may alter biomarker levels and increase the risk of ARDS independently of trauma).
• n. End-stage chronic liver disease (to avoid altered inflammatory responses and poor clinical outcomes unrelated to chest trauma).
• o. End-stage renal disease requiring dialysis (to avoid altered clearance of circulating biomarkers and independently increased mortality risk).
• p. Active malignancy receiving chemotherapy or radiotherapy (to exclude patients with cancer-related systemic inflammation and immunosuppression that may affect biomarker levels and outcomes).
• q. Pregnancy (because physiological changes during pregnancy may influence biomarker levels and respiratory function).
• r. Patients transferred from another hospital more than 24 hours after injury (to ensure standardized early clinical assessment and biomarker sampling within the predefined study period).
• s. Refusal to participate in the study (because informed consent is required for study enrollment).
• t. Connective tissue diseases
• u. Severe burns and major inhalational injury v. Immunosuppressive therapy
• w. Chronic systemic inflammatory diseases
• x. Severe obesity ( BMI>40), if relevant.
• y. Poly trauma with AIS> or = 3 outside the chest.