Intravenous n-acetylcysteine, ascorbic acid and selenium-based anti-oxidant therapy in severe acute pancreatitis.
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.
Virlos
I T
IT
Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
Mason
J
J
Schofield
D
D
McCloy
R F
RF
Eddleston
J M
JM
Siriwardena
A K
AK
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
D000975:Antioxidants; D019207:beta Carotene; D024502:alpha-Tocopherol; D012643:Selenium; D001205:Ascorbic Acid; D000111:Acetylcysteine