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.