title: Markers of Oxidative Stress and Clinical Outcome in Critically ill Septic Patients: A Preliminary Study from North India.
abstract: BACKGROUND
  Sepsis is the leading cause of mortality in non-coronary Intensive Care Units (ICUs). Oxidative stress is one of the important features in pathogenesis of sepsis.
  
  
  OBJECTIVE
  This study was undertaken to evaluate levels of oxidants and antioxidants in patients with sepsis admitted to ICU.
  
  
  METHODS
  This was a non-interventional clinical case-control study undertaken at a tertiary level teaching hospital in New Delhi, India.
  
  
  METHODS
  Forty-six consecutive non-pediatric patients admitted to ICU with sepsis were included and subjected to detailed history, physical examination and investigations. Blood samples were drawn to evaluate oxidant Malondialdehyde (MDA) and antioxidant (alpha-tocopherol) levels. Acute Physiology and Chronic Health Evaluation II (APACHE II) and Organ Dysfunction and/or Infection (ODIN) scores were calculated and patients followed up for outcomes. Twenty age and sex matched healthy subjects served as controls.
  
  
  RESULTS
  Mean levels of malondialdehyde were higher in patients than controls (17.2±3.8nm/ml versus 4.6±1.6nm/ml, p<0.001) while levels of alpha-tocopherol were lower (3.2±1.3μg/ml versus 9.9±2.0μg/ml, p<0.001). The mean APACHE II and ODIN scores were 18.1±9.3 and 1.7±1.3 respectively in patients. These scores were two to three fold higher in non survivor patients (n=22) in comparison with survivors (n=18) (p<0.001). There was no significant difference between the two groups in oxidants and antioxidants levels (p>0.05). However, a significant and positive correlation was observed between oxidant -antioxidant levels and APACHE II, ODIN and International Normalized Ratio (INR) scores in septic patients overall.
  
  
  CONCLUSIONS
  The oxidants in septic patients were significantly higher while antioxidants were significantly lower than healthy controls. There was also a significant correlation with APACHE II and ODIN scores. A large patient population based study may draw more specific conclusions.
authors.affiliation: Director Professor, Department of Medicine, Maulana Azad Medical College , New Delhi, India .
authors.forename: Mradul Kumar
authors.initials: MK
authors.lastname: Daga
authors.affiliation: Research Associate, Department of Medicine, Maulana Azad Medical College , New Delhi, India .
authors.forename: Naushad Ahmad
authors.initials: NA
authors.lastname: Khan
authors.affiliation: Assistant Professor, Department of Medicine, Maulana Azad Medical College , New Delhi, India .
authors.forename: Harpreet
authors.initials: H
authors.lastname: Singh
authors.affiliation: Senior Resident, Department of Medicine, Maulana Azad Medical College , New Delhi, India .
authors.forename: Ankit
authors.initials: A
authors.lastname: Chhoda
authors.affiliation: Resident, Department of Medicine, Maulana Azad Medical College , New Delhi, India .
authors.forename: Sahil
authors.initials: S
authors.lastname: Mattoo
authors.affiliation: Resident, Department of Medicine, Maulana Azad Medical College , New Delhi, India .
authors.forename: Basant Kumar
authors.initials: BK
authors.lastname: Gupta
keywords: APACHE II; Antioxidants; ICU; Oxidants; Sepsis