We assessed whether at admission plasma circulating cell free mitochondrial DNA (ccf-mtDNA) is related to injury severity and can predict morbidity and mortality in acute trauma patients. Patients were evaluated at Emergency Department (ED) using Injury Severity Scale (ISS), but only patients required ICU admission were studied (Group B). At ED arrival, blood samples were obtained for quantitative real-time PCR estimation of plasma level of ccf-mtDNA. Study outcome was the correlation between morbidity and mortality and at admission plasma ccf-mtDNA level and its predictability for morbidity and mortality. Ten healthy volunteers gave blood samples as control group (Group B). Twenty-seven patients passed smooth ICU stay and were discharged alive (Group B1), while 34 patients developed additional morbidities (Group B2) and 11 patients (18%) of Group A2 died. Mean estimated plasma ccf-mtDNA levels were significantly higher in Group B than in Group A, but patients of Group B1 had significantly lower ccf-mtDNA levels than patients of Group B2. Patients developed adult respiratory distress syndrome (ARDS) had significantly higher ccf-mtDNA levels than patients developed sepsis or acute myocardial infarction (AMI) with significantly higher levels in patients developed sepsis. Estimated plasma ccf-mtDNA levels at time of admission showed positive significant correlation with morbidity rate. Odds ratio (OR) for relative risk for development of additional morbidities in patients who had a high plasma ccf-mtDNA level was 26.35. At admission plasma ccf-mtDNA levels in survivors were significantly lower than in non-survivors, and OR was 4.0806. High plasma ccf-mtDNA showed high sensitivity as predictor for ICU mortality. High at ED admission plasma ccf-mtDNA levels could predict development of additional morbidities during ICU stay of acute trauma patients and showed high sensitivity for prediction of their survival. Very high plasma ccf-mtDNA levels could predict patients liable to develop ARDS.