Injury severity and serum amyloid A correlate with plasma oxidation-reduction potential in multi-trauma patients: a retrospective analysis

Abstract

BackgroundIn critical injury, the occurrence of increased oxidative stress or a reduced antioxidant status has been observed. The purpose of this study was to correlate the degree of oxidative stress, by measuring the oxidation-reduction potential (ORP) of plasma in the critically injured, with injury severity and serum amyloid A (SAA) levels.MethodsA total of 140 subjects were included in this retrospective study comprising 3 groups: healthy volunteers (N = 21), mild to moderate trauma (ISS < 16, N = 41), and severe trauma (ISS ≥ 16, N = 78). For the trauma groups, plasma was collected on an almost daily basis during the course of hospitalization. ORP analysis was performed using a microelectrode, and ORP maxima were recorded for the trauma groups. SAA, a sensitive marker of inflammation in critical injury, was measured by liquid chromatography/mass spectrometry.ResultsORP maxima were reached on day 3 (± 0.4 SEM) and day 5 (± 0.5 SEM) for the ISS < 16 and ISS ≥ 16 groups, respectively. ORP maxima were significantly higher in the ISS < 16 (-14.5 mV ± 2.5 SEM) and ISS ≥ 16 groups (-1.1 mV ± 2.3 SEM) compared to controls (-34.2 mV ± 2.6 SEM). Also, ORP maxima were significantly different between the trauma groups. SAA was significantly elevated in the ISS ≥ 16 group on the ORP maxima day compared to controls and the ISS < 16 group.ConclusionThe results suggest the presence of an oxidative environment in the plasma of the critically injured as measured by ORP. More importantly, ORP can differentiate the degree of oxidative stress based on the severity of the trauma and degree of inflammation.

Role of Oxidative Stress in the Clinical Outcome of Patients with Multiple Blunt Trauma

“…27 In one study, injury severity and serum amyloid A levels were correlated with plasma oxidation-reduction potential (ORP) in patients with MBT, and there was a significant association between plasma ORP and severity of injury. 28 The present study found that plasma TOS and OSI levels were significantly higher, and plasma TAS levels were significantly lower, in MBT patients compared with control subjects; this suggests a positive correlation between degree of oxidative stress and severity of injury. TOS level, as a marker of early oxidative stress, may reflect the severity of injury and provide an early indication of clinical outcome.…”

Post-translational oxidative modification of fibrinogen is associated with coagulopathy after traumatic injury

“…Thioredoxin cycling can also become inhibited during hemorrhagic shock by expression of a family of thioredoxin-interacting proteins that can directly inhibit the expression and reducing activity of thioredoxin [33,34]. Additional support for an unbalancing of blood redox balance after trauma is provided by Rael and colleagues who found that plasma oxidation-reduction potential was significantly elevated in trauma patients and could be used to discriminate between mild and severe injury profiles [35]. Therefore, our observation of subtly-increased methionine sulfoxide content of fibrinogen may suggest disruption of local sulfonyl redox balance either from inflammatory leukocyte activation (a common feature of trauma), a reduced antioxidant capacity, or both.…”

Traumatic Brain Injury Causes Endothelial Dysfunction in the Systemic Microcirculation through Arginase-1–Dependent Uncoupling of Endothelial Nitric Oxide Synthase

“…Similar ORP increases were recently reported in humans with severe trauma, specifically TBI. 36,37 Our results suggest that larginine depletion and eNOS uncoupling associated with TBI are responsible for the increase in endothelial ROS, which would place ROS elevation downstream of arginase and l-arginine depletion.…”

“…Thawed samples (30 lL) were tested using the RedoxSYS diagnostic platform, consisting of a micro Pt/AgCl combination redox electrode sensor and benchtop analyzer (Aytu Bioscience, Inc., CO). 36,37 Values were recorded in millivolts (mV) after ORP readings were stable for 10 sec. The diagnostic platform was calibrated before use and validated with hydrogen peroxide (30 lM) as a positive control.…”