Background: Traumatic hemorrhagic shock is a condition associated with a high mortality rate in the absence of timely diagnose and intervention. The class and severity of hemorrhagic shock are the key factors that guide the decisions in the management of these patients. This study aims to provide guidance for the timely administration of an appropriate treatment to patients with traumatic hemorrhagic shock, and thus, decrease morbidity and mortality, by determining shock severity and class more clearly with the use of the thiol disulfide homeostasis balance, which is an objective criterion.
Methods: This controlled, prospective, and clinical study was conducted in the Emergency Medicine Clinic at the University of Health Sciences, Ankara Numune Training and Research Hospital between October 1, 2018 and April 30, 2019. Thiol disulfide homeostasis was assessed in blood collected from patients and healthy volunteers. A total of one hundred two patients were included; of whom 52 were female and male volunteer patients aged 18 or older who presented to the emergency department with traumatic hemorrhagic bleeding and fifty were control subjects.
Results: Patient and control groups demonstrated significantly different native thiol, total thiol, disulfide, disulfide/native thiol, and disulfide/total thiol levels (P-values for native thiol, total thiol, disulfide, disulfide/native thiol, and disulfide/total thiol: 0.001>, 0.001>, 0.018, 0.002, and 0.002, respectively). According to pairwise comparisons; Class-3 hemorrhagic shock was associated with significantly lower native thiol and total thiol levels compared to Class-1 and Class-2 hemorrhagic shock (Comparison of Class-1 and Class-3 hemorrhagic shock: p-value for native thiol = 0.001, p-value for total thiol = 0.002) (Comparison of Class-2 and Class-3 hemorrhagic shock: p-value for native thiol = 0.009, p-value for total thiol = 0.006). Total thiol levels were found to be lower in patients who died compared to those who survived (p=0.040).
Conclusion: Thiol disulfide homeostasis data were found to be correlated with the shock class and mortality. The assessment of thiol disulfide homeostasis can serve as a guide in the determination of the severity and classification of the disease, evaluation of the prognosis, and management of the treatment in traumatic hemorrhagic shock patients.