Efficacy of serum nitric oxide level estimation in assessing the severity of necrotizing pancreatitis

The role of nitric oxide in the pathophysiology of necrotizing pancreatitis is unclear.

In a prospective study, the clinical course of 40 patients diagnosed as having acute necrotizing pancreatitis was followed using computed tomography severity score (CTSS) and serial APACHE II scoring. The serum nitric oxide levels in the form of reactive nitrogen intermediates (RNI) were estimated on admission and on day 3. Occurrence of complications, need for intervention, incidence of organ failure, and outcome were noted. The efficacy of CTSS, APACHE II scores, and RNI levels in predicting morbidity and mortality was assessed. The correlation between CTSS, APACHE II scores, and RNI levels was studied.

The study group showed significantly higher levels of RNI as compared with the control group (159.1 vs. 106.0 nmol/ml, p < 0.05). The RNI levels were not affected by the occurrence of local complications or distant-organ failure. The RNI levels on admission were significantly higher in the subset of patients who developed bacterial sepsis (195.5 vs. 134.7 nmol/ml, p < 0.05). The RNI levels on admission in the non-survivors were higher as compared with those of the survivors (216.0 vs. 140.1 nmol/ml, p < 0.05). There was a significant positive correlation between the RNI levels and the CTSS in these patients (p < 0.05). There was no correlation between RNI levels and APACHE II scores.

Acute necrotizing pancreatitis is associated with raised serum nitric oxide levels at its early stage. Patients with higher serum nitric oxide levels are at a significantly higher risk of sepsis and mortality.