Redefining Prognosis in Acute Pancreatitis: The Emerging Role of Antioxidant Biomarkers

Oxidative stress (OS) plays a central role in triggering proinflammatory cascades in Acute Pancreatitis (AP). Evidence supports that antioxidant status is a key determinant of severity in human AP. Our study evaluates the plasma antioxidant capacity in patients admitted with AP and its relationship with disease severity.

Prospective recruitment of patients hospitalized for AP. Clinical and demographic data were recorded. Blood samples were obtained at 24, 48, and 72 hours after admission. Total antioxidant capability was assessed using ferric reducing antioxidant power (FRAP), ABTS radical scavenging capacity, and catalase activity. AP severity was classified according to the Revised Atlanta Classification.

A total of 91 patients were studied, 75 suffered from a mild episode of AP (MAP), and 16 developed moderately-severe/severe AP (MSAP-SAP). FRAP levels were significantly lower at 24, 48, and 72 hours in MSAP-SAP patients compared with those with MAP. Catalase activity on admission was significantly higher in MAP patients than in MSAP-SAP patients. Multivariate logistic regression identified 2 predictive models for MSAP-SAP. A cut-off of 0.063 (AUC 0.81, 95% IC 0.669-0.947) in model 1 and a cut-off of 0.100 in model 2 (AUC 0.83, 95% IC 0.706-0.958) demonstrated good sensitivity and specificity in discriminating MSAP-SAP patients.

Reduced plasma antioxidant levels in the early stages of AP are independently associated with greater disease severity and may serve as early prognostic biomarkers.