Context Release of oxygen free radicals is increased in acute pancreatitis, but whether this can be used to predict clinical severity is not known. Objective This study assesses whether plasma concentrations of malondialdehyde (a marker of lipid peroxidation) and superoxide dismutase (an oxygen free radical scavenger) can be used to predict severity of acute pancreatitis. Patients Fifty-one patients with acute pancreatitis and two control groups were recruited. Main outcome measures Plasma levels of malondialdehyde and erythrocyte content of superoxide dismutase were measured at 0, 12, 24, 48, 72, 96 and 120 hours after admission. Acute physiology and chronic health evaluation (APACHE) II, Glasgow and Ranson scores were calculated. Acute pancreatitis severity was defined by Atlanta criteria. Premorbid antioxidant intake was assessed by dietary questionnaire. Results Levels of malondialdehyde were raised in acute pancreatitis patients and increased in patients with severe compared with mild acute pancreatitis; 12 hours after admission plasma malondialdehyde was 4.42±0.54 mmol/L and 2.95±0.24 mmol/L in severe and mild pancreatitis, respectively (mean±SEM; P=0.007). Plasma malondialdehyde greater than 2.75 mmol/L at 12 hours after admission had high overall accuracy for predicting severe acute pancreatitis. Superoxide dismutase levels were found to decrease in acute pancreatitis but no substantial significant difference was demonstrated between severe and mild acute pancreatitis patients. There was no difference in pre-morbid antioxidant dietary intake between the mild and severe pancreatitis groups. Conclusion Plasma malondialdehyde may be a helpful additional marker of severity in the very early stages of acute pancreatitis.
Mohammed Abu-Hilal, Mark JW McPhail, Lucy Marchand, Colin D Johnson