title: Intravenous n-acetylcysteine, ascorbic acid and selenium-based anti-oxidant therapy in severe acute pancreatitis.
abstract: BACKGROUND
  To observe outcome in a cohort of patients with severe acute pancreatitis receiving multiple anti-oxidant therapy.
  
  
  METHODS
  An observational study was carried out in 46 consecutive patients with acute pancreatitis fulfilling current Atlanta consensus criteria for severe disease. All patients received multiple anti-oxidant therapy based on intravenous selenium, N-acetylcysteine and ascorbic acid plus beta-carotene and alpha-tocopherol delivered via nasogastric tube. Principal outcomes were the effect of anti-oxidant supplementation on anti-oxidant levels, morbidity and mortality in patients on anti-oxidant therapy, case-control analysis of observed survival compared to predicted survival derived from logistic organ dysfunction score (LODS), logistic regression analysis of factors influencing outcome and side effect profile of anti-oxidant therapy.
  
  
  RESULTS
  Paired baseline and post-supplementation data were available for 25 patients and revealed that anti-oxidant supplementation restored vitamin C (P = 0.003) and selenium (P = 0.028) toward normal. In univariate survival analysis, patient survival to discharge was best predicted by admission APACHE-II score with relative risk of death increasing 12.6% for each unit increase (95% CI 6.0% to 19.6%). The mean LODS calculated on admission to hospital was 3.7 (standard error of the mean 4.1) giving a predicted mortality for the cohort of 21%. The observed in-hospital mortality was 43%.
  
  
  CONCLUSIONS
  Case-control analyses do not appear to demonstrate any benefit from the multiple anti-oxidant combination of selenium, N-acetylcysteine and ascorbic acid in severe acute pancreatitis.
authors.affiliation: Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
authors.forename: I T
authors.initials: IT
authors.lastname: Virlos
authors.forename: J
authors.initials: J
authors.lastname: Mason
authors.forename: D
authors.initials: D
authors.lastname: Schofield
authors.forename: R F
authors.initials: RF
authors.lastname: McCloy
authors.forename: J M
authors.initials: JM
authors.lastname: Eddleston
authors.forename: A K
authors.initials: AK
authors.lastname: Siriwardena
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism; D001205:Ascorbic Acid / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D010195:Pancreatitis / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D012643:Selenium / Q000008:administration & dosage*; D015996:Survival Rate; D024502:alpha-Tocopherol / Q000008:administration & dosage; D019207:beta Carotene / Q000008:administration & dosage
chemical_list: D000975:Antioxidants; D019207:beta Carotene; D024502:alpha-Tocopherol; D012643:Selenium; D001205:Ascorbic Acid; D000111:Acetylcysteine