Serum thiol levels and thiol/disulphide homeostasis in gunshot injuries
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.
KeywordsThiol 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.
A written informed consent was obtained from patients or their legal guardians.
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.
- 1.Oymacı E, Kapkaç M, Uçar Y, Ertan H, Özdedeli E, Tokat Y. The effects of gunshot and shotgun wounds to mortality and morbidity. Turkish J Trauma Emerg Surg. 1997;3:132–6.Google Scholar
- 2.Hoyt DB, Potenza BM, Cryer HG, et al. Trauma. In: Greenfield LJ, Mullholland MW, Oldham KT, Zelenock GB, Lilimoe KD, editors. Surgery:Scientific Principles and Practise. 2nd ed. Philadelphia: Lippincott-Raven; 1997. pp. 267–421.Google Scholar
- 3.Eriş S, Orak M, Al B, Güloğlu C, Aldemir M. factors affecting mortality in patients with gunshot injuries. Marmara Medical Journal. 2009;22(3):181–91.Google Scholar
- 4.Papurica M, Rogobete AF, Sandesc D, Dumache R, Nartita R, Sarandan M, Cradigati AC, Luca L, Vernic C, Bedreag OH. Redox changes induced by general anesthesia in critically Ill patients with multiple trauma. Mol Biol Int. 2015;2015:238586. https://doi.org/10.1155/2015/238586. (Review).CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Yıldırım A, Aslan Ş, Ocak T, Yıldırım S, Kara F, Şahin YN. Serum paraoxonase/arylesterase activities and malondialdehyde levels in trauma patients. Eurasian J Med. 2007;39(2):85–8.Google Scholar
- 12.Velioglu S. Effects of natural antioxidants on human health. Gıda. 2000;25 (3):167–76.Google Scholar
- 17.Lilios G, Pasare R, Malcea L, Radulescu N. The evaluatıon of oxidative stress in traumatic shock. Cercet Exp Med Chir. 2006;2(1):127–30.Google Scholar
- 26.Peleg K, Aharonson-Daniel L, Stein M, Michaelson M, Kluger Y, Simon D, Noji EK, Israeli Trauma Group (ITG). Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel. Ann Surg. 2004;239(3):311–8.CrossRefPubMedPubMedCentralGoogle Scholar