Serum thiol levels and thiol/disulphide homeostasis in gunshot injuries

  • Hasan Buyukaslan
  • Umut Gulacti
  • Mehmet Tahir Gökdemir
  • Ramazan Giden
  • Hakim Celik
  • Özcan Erel
  • Erman Mustafa Dörterler
Original Article



Gunshot injuries result in serious traumatic tissue damage due to high velocity of the bullet, deep penetration, and ballistic effect. Trauma is known to be related with oxidative stress. Serum thiol levels and disulphide/thiol homeostasis are novel oxidative stress biomarkers. In this study, we aimed to investigate serum thiol levels and disulphide/thiol homeostasis in injury patterns of patients admitted to the emergency department with a gunshot injury.


A total of 128 participants were included in the study. The participants were divided into two groups: the patient group (Group 1; n = 73) and healthy controls (Group 2; n = 55). Native thiol, total thiol, disulphide levels, disulphide/native thiol, disulphide/total thiol, and neutrophil-to-lymphocyte ratio (NLR) were measured. The Revised Trauma Scale (RTS) and Glasgow Coma Scale (GCS) scores were calculated.


Native thiol, total thiol, and disulphide levels were significantly lower in Group 1 (p < 0.001). Disulphide/native thiol ratio, disulphide/total thiol ratio, and NLR were significantly higher in Group 1, compared to Group 2 (p < 0.05). There was a positive correlation between thiol levels and RTS and GCS scores and NLR. Stepwise linear regression analysis showed that native thiol was an independent indicator of RTS and GCS scores. The receiver operating characteristic curve (ROC) analysis revealed that serum native thiol levels of ≤ 342.9 could predict gunshot injury with a sensitivity of 82% and a specificity of 77% (area under the curve = 0.853; 95% confidence interval 0.783–0.924).


Our study results suggest that thiol–disulphide homeostasis is disrupted in patients sustaining gunshot injuries, and thiol levels decrease in correlation with the severity of trauma with a high sensitivity and specificity. As the level of native thiol is an independent predictor of the severity of trauma, reduced thiol levels may be of prognostic value in the early assessment of patients in the emergency room.


Thiol Thiol–disulphide homeostasis Gunshot injury Emergency department Neutrophil-to-lymphocyte ratio 




Compliance with ethical standards

Conflict of interest

Buyukaslan Hasan, Gulacti Umut, Gökdemir Mehmet Tahir, Giden Ramazan, Celik Hakim, Erel Özcan, and Dörterler Mustafa Erman declare that they have no conflict of interest.

Informed consent

A written informed consent was obtained from patients or their legal guardians.

Ethical approval

The study protocol was approved by the Ethics Committee of Harran University, Faculty of Medicine. The study was conducted in accordance with the principles of the Declaration of Helsinki.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hasan Buyukaslan
    • 1
  • Umut Gulacti
    • 2
  • Mehmet Tahir Gökdemir
    • 3
  • Ramazan Giden
    • 4
  • Hakim Celik
    • 5
  • Özcan Erel
    • 6
  • Erman Mustafa Dörterler
    • 7
  1. 1.Department of Emergency MedicineHarran University Education and Research HospitalŞanliurfaTurkey
  2. 2.Department of Emergency MedicineAdiyaman University Medical FacultyAdiyamanTurkey
  3. 3.Emergency DepartmentGazi Yaşargil Education and Research HospitalDiyarbakirTurkey
  4. 4.Department of Emergency MedicineMehmet Akif İnan Education and Research HospitalŞanliurfaTurkey
  5. 5.Department of PhysiologyHarran University Education and Research HospitalŞanliurfaTurkey
  6. 6.Department of BiochemistryAnkara Atatürk Training and Research HospitalAnkaraTurkey
  7. 7.Department of Pediatric SurgeryHarran University Education and Research HospitalŞanliurfaTurkey

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