A prospective study exploring parathyroid hormone as a biomarker in haemorrhagic shock resuscitation

Lactate and base excess are being utilized for management and prognostication in trauma patients despite their inherent limitations. Recently, parathyroid hormone (PTH) showed better accuracy in predicting blood transfusion and mortality compared with lactate. This study compared the utility of lactate, base excess, and PTH as biomarkers in trauma resuscitation as well as outcome.

A prospective observational study was performed at a Level I trauma centre in consecutive adult patients presenting primarily with at least class III trauma haemorrhagic shock from January 2021 to December 2023. Eighty-two patients were included. The comparison was done based on resuscitation response, mortality and need for emergency surgical intervention. Most of them sustained blunt injuries, the mean age was (34.3 ± 12.6) years, and 80% were men. PTH measurement was added to the standard laboratory workup on presentation and subsequently during resuscitation. The categorical variables were analysed using Chi-square test whereas continuous variables were analysed with student t-test. The data were analysed using SPSS 30 software.

Patients who were non-responders to initial resuscitation measures (28.0%) had significantly higher mean initial lactate levels compared with responders (5.9 ± 4.5 vs. 7.6 ± 4.3; p = 0.043). Base excess and PTH level difference were not statistically significant. No biomarkers were significantly different between patients needing emergency surgery in comparison to those who did not. Initial mean base excess levels were significantly high in the deceased group compared with survivors (-12.0 ± 7.4 vs. -8.5 ± 5.6; p = 0.071). At reassessment, all 3 biomarkers were significantly different between survivors and non-survivors.

Lactate, base excess, and PTH in isolation could not predict response and outcomes among trauma patients with haemorrhagic shock. Failure of these markers to normalize over time was associated with significantly higher need for blood product transfusion as well as mortality.