Background. Sulfur mustard (SM), as chemical warfare, has a delayed effect on exposed veterans. This study assessed the metabolic parameters in veterans with different severities of exposure.

Methods. The study was conducted on two volunteer groups. 1) SM-exposed group, exposed to SM once in 1987 during the war; divided into three subgroups based on the injury severity, asymptom (without any clinical signs), mild, and severe; 2) Non-exposed group. Nine metabolic biomarkers were measured and compared between groups. Principal component (PC) analysis was performed to determine the most contributing biomarkers in each severity of SM exposure.

Results. The SM-exposed group had higher levels of cholesterol and hemoglobin than the non-exposed group (P < 0.01). The levels of aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyltransferase (GGT), triglyceride, high-density-lipoprotein (HDL), low-density lipoprotein (LDL), and creatinine did not indicate any difference between the two groups (P > 0.05). The cholesterol level was increased in the asymptom, mild, and severe subgroups compared to the non-exposed group (p < 0.05). The hemoglobin was only increased in the severe subgroup compared to mild, asymptom, and non-exposed groups (p < 0.05). PC analysis determined that the biomarker of cholesterol is most contributing to interpatient variation in the total SM-exposed group and asymptom and mild subgroups while the biomarker of AST is predominant in the severe subgroup.

Conclusion. Sulfur mustard exposure results in long-term metabolic changes, notably elevated cholesterol in all exposed subgroups. PC data identified cholesterol as the main biomarker in asymptom and mild exposed veterans, and AST as predominant in severe veterans.