{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:02:50Z","timestamp":1789448570622,"version":"build-2803163510"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"\n Background<\/jats:title>\n Trauma-induced coagulopathy (TIC) is characterized by marked heterogeneity, and conventional classification methods have limited ability to capture its dynamic progression, frequently failing to account for inter-individual variability. This study aimed to develop a framework for identifying glucose trajectory phenotypes based on early blood glucose trajectories and to evaluate their association with 28-day mortality.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective analysis was performed using data from 905 trauma patients in the discovery cohort obtained from the MIMIC-IV database and 260 trauma patients in a validation cohort from Hebei Medical University Third Hospital. Least absolute shrinkage and selection operator regression analysis was applied to identify prognostic variables, followed by the development and comparative evaluation of 12 machine learning models. Group-based trajectory modeling (GBTM) was used to characterize dynamic blood glucose trajectory patterns during the first 7 days following admission, and their associations with clinical outcomes were examined.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Six key prognostic variables were identified: red cell distribution width (RDW), white blood cell count, blood glucose, anion gap, lactate, and pH. The logistic classifier model achieved an area under the curve of 0.785 in the discovery cohort and 0.761 in the validation cohort, with acceptable calibration (ECE\u00a0=\u00a00.119). Among 184 eligible patients in the discovery cohort. GBTM identified three distinct blood glucose trajectory patterns: declining-then-stabilizing, persistently fluctuating, and stabilizing-then-rising. The stabilizing-then-rising trajectory pattern was significantly associated with the highest 28-day mortality (\n p<\/jats:italic>\n \u00a0=\u00a00.034, adjusted OR 3.879, 95% CI 3.101-4.886, p &lt; 0.001 in the pooled analysis, n = 1,165), a finding that was further confirmed in the validation cohort (\n p<\/jats:italic>\n \u00a0&lt;\u00a00.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Application of GBTM to early blood glucose trajectories enables the identification of glucose trajectory phenotypes associated with differential mortality risk. This approach may provide a novel framework for dynamic risk stratification and targeted clinical management.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fendo.2026.1839373","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:26:21Z","timestamp":1789446381000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Machine learning\u2013based prognostic prediction and subphenotype identification in trauma-induced coagulopathy using early blood glucose trajectories"],"prefix":"10.3389","volume":"17","author":[{"given":"Guang-Yue","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-Qi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan-Hong","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiao-Ling","family":"Lou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin-Liang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.1240","article-title":"Road traffic accidental injuries and deaths: A neglected global health issue","volume":"6","author":"Ahmed","year":"2023","journal-title":"Health Sci Rep"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0233274","article-title":"Risk factors for blood transfusion in traumatic and postpartum hemorrhage patients: Analysis of the CRASH-2 and WOMAN trials","volume":"15","author":"Kolin","year":"2020","journal-title":"PloS One"},{"key":"B3","unstructured":"The European guideline on management of major bleeding and coagulopathy following trauma: Fifth edition\n \n \n \n Spahn\n DR\n \n \n Bouillon\n B\n \n \n Cerny\n V\n \n \n \n 2019"},{"key":"B4","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s40779-021-00317-4","article-title":"Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy","volume":"8","author":"Song","year":"2021","journal-title":"Mil Med Res"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14414","article-title":"Platelets retain inducible alpha granule secretion by P-selectin expression but exhibit mechanical dysfunction during trauma-induced coagulopathy","volume":"17","author":"Rani","year":"2019","journal-title":"J Thromb Haemostasis: JTH"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.4103\/ajns.ajns_126_19","article-title":"Trauma-induced coagulopathy: Incidence and outcome in patients with isolated traumatic brain injury in a level I trauma care center in India","volume":"14","author":"Rani","year":"2019","journal-title":"Asian J Neurosurg"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.767637","article-title":"Pathophysiology of coagulopathy induced by traumatic brain injury is identical to that of disseminated intravascular coagulation with hyperfibrinolysis","volume":"8","author":"Wada","year":"2021","journal-title":"Front Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2019.01.014","article-title":"Discrepancies between conventional and viscoelastic assays in identifying trauma-induced coagulopathy","volume":"217","author":"Sumislawski","year":"2019","journal-title":"Am J Surg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2018.6234","article-title":"Fibrinolytic activation in patients with progressive intracranial hemorrhage after traumatic brain injury","volume":"38","author":"Fair","year":"2021","journal-title":"J Neurotrauma"},{"key":"B10","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1097\/ta.0000000000003874","article-title":"A proposed clinical coagulation score for research in trauma-induced coagulopathy","volume":"94","author":"Eitel","year":"2023","journal-title":"J Trauma Acute Care Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1055\/a-2215-8936","article-title":"Pathophysiology of trauma-induced coagulopathy","volume":"44","author":"Sch\u00f6chl","year":"2024","journal-title":"Hamostaseologie"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0322043","article-title":"Unveiling hub genes and biological pathways: A bioinformatics analysis of trauma-induced coagulopathy (TIC)","volume":"20","author":"Zhang","year":"2025","journal-title":"PloS One"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15111435","article-title":"Trauma-induced coagulopathy: A review of specific molecular mechanisms","volume":"15","author":"Capponi","year":"2025","journal-title":"Diagnostics (Basel Switzerland)"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.47102\/annals-acadmedsg.2020381","article-title":"Trauma-induced coagulopathy: Mechanisms and clinical management","volume":"51","author":"Ho","year":"2022","journal-title":"Ann Acad Medicine Singapore"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022019164","article-title":"A novel melanocortin fusion protein inhibits fibrinogen oxidation and degradation during trauma-induced coagulopathy","volume":"142","author":"Han","year":"2023","journal-title":"Blood"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14450","article-title":"Trauma-induced coagulopathy: The past, present, and future","volume":"17","author":"Kornblith","year":"2019","journal-title":"J Thromb Haemostasis: JTH"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0307905","article-title":"Longitudinal trajectories of blood glucose and 30-day mortality in patients with diabetes mellitus combined with acute myocardial infarction: A retrospective cohort analysis of the MIMIC database","volume":"19","author":"Deng","year":"2024","journal-title":"PloS One"},{"key":"B18","unstructured":"Long-term longitudinal patterns of patient-reported fatigue after breast cancer: A group-based trajectory analysis\n \n \n \n Vaz-Luis\n I\n \n \n Di Meglio\n A\n \n \n Havas\n J\n \n \n \n 2022"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1177\/10760296221139258","article-title":"Establishment of a predictive model for poor prognosis of incomplete revascularization in patients with coronary heart disease and multivessel disease","volume":"28","author":"Lian","year":"2022","journal-title":"Clin Appl Thrombosis\/Hemostasis: Off J Int Acad Clin Appl Thrombosis\/Hemostasis"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaf378","article-title":"Plasma sphingolipids in relation to glycemia and glucose tolerance in people without diabetes","volume":"111","author":"Asuzu","year":"2025","journal-title":"J Clin Endocrinol Metab"},{"key":"B21","unstructured":"Effect of 24 h glucose fluctuations on 30-day and 1-year mortality in patients with acute myocardial infarction: An analysis from the MIMIC-III database\n \n \n \n Liu\n X\n \n \n Zhang\n G\n \n \n Li\n D\n \n \n \n 2024"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0318774","article-title":"Diabetic ketoacidosis and hyperglycemic hyperosmolar state are associated with higher in-hospital mortality and morbidity in diabetes patients hospitalized with ST-elevation myocardial infarction, but not within 30 days of readmission","volume":"20","author":"Almutairi","year":"2025","journal-title":"PloS One"},{"key":"B23","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1186\/s12967-024-05516-w","article-title":"Current landscape and comprehensive management of glycemic variability in diabetic retinopathy","volume":"22","author":"Chen","year":"2024","journal-title":"J Transl Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1097\/aco.0000000000001350","article-title":"Stress hyperglycaemia following trauma \u2013 a survival benefit or an outcome detriment","volume":"37","author":"Rugg","year":"2024","journal-title":"Curr Opin Anaesthesiology"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0323085","article-title":"Association between stress hyperglycemia ratio and poor outcomes in trauma surgery ICU patients","volume":"20","author":"Cao","year":"2025","journal-title":"PloS One"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-023-02405-7","article-title":"Do admission glucose levels independently predict coagulopathy in multiple trauma patients? A retrospective cohort analysis","volume":"50","author":"Mayor","year":"2024","journal-title":"Eur J Trauma Emerg Surg"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.14521","article-title":"The diagnostic utility of prehospital hyperglycaemia in major trauma patients: An observational study","volume":"37","author":"Shahab","year":"2025","journal-title":"Emerg Med Australas"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1097\/ta.0000000000001993","article-title":"Acute hyperglycemia exacerbates trauma-induced endothelial and glycocalyx injury: An in vitro model","volume":"85","author":"Diebel","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-02908-9","article-title":"Continuous glucose monitoring and intrapersonal variability in fasting glucose","volume":"30","author":"Shilo","year":"2024","journal-title":"Nat Med"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0306107","article-title":"Blood glucose and lactate levels as early predictive markers in patients presenting with cardiogenic shock: A retrospective cohort study","volume":"19","author":"Billig","year":"2024","journal-title":"PloS One"},{"key":"B31","unstructured":"Evaluation of clinical prediction models (part 2): How to undertake an external validation study\n \n \n \n Riley\n RD\n \n \n Archer\n L\n \n \n Snell\n KIE\n \n \n \n 2024"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.70082\/nj450r10","article-title":"The role of viscoelastic hemostatic assays (TEG and ROTEM) in goal-directed hemostatic resuscitation for trauma-induced coagulopathy: A laboratory specialist\u2019s guide to principles, analytical quality, andclinical interpretation","volume":"20","author":"Amlak","year":"2024","journal-title":"Rev Diabetic Stud"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1839373\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:26:24Z","timestamp":1789446384000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1839373\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":32,"alternative-id":["10.3389\/fendo.2026.1839373"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1839373","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]},"article-number":"1839373"}}