Systematic Review of Role of Oxidative Stress and Clinical Implications in Acute Pancreatitis

This systematic review evaluates oxidative stress markers (OSM) in acute pancreatitis (AP) and their role in predicting AP severity and outcomes.

Prospective observational studies evaluating OSM in adults with AP were identified through systematic searches of PubMed, Embase, Web of Science and Cochrane Library from database inception to the final search date, with no date restrictions owing to limited available literature. Studies in all languages were initially screened, but only those with accessible English full texts were eligible for inclusion. Study selection, data extraction and quality assessment were performed independently by two reviewers. Differences in AP severity definitions were recorded and considered during analysis.

Nineteen prospective observational studies (1998-2023) evaluated oxidative stress and antioxidant biomarkers in adults with acute pancreatitis. Across studies, OSMs were consistently elevated in AP and increased further with disease severity. Lipid peroxidation products and reactive oxygen species, including malondialdehyde (MDA), thiobarbituric acid reactive substances (TBARS), superoxide radicals and thioredoxin-1 (TRX-1), were significantly higher in severe AP (SAP) and correlated with systemic complications and CT severity scores (p = 0.007 to < 0.010). In contrast, antioxidant defences were reduced in SAP, with lower levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), ascorbic acid and transferrin sialylation levels associated with persistent organ failure, mortality and increased inflammatory burden (p = 0.005 to < 0.001). The oxidative stress index (OSI) correlated with 48-h Ranson scores (p = 0.027), reflecting a systemic pro-oxidant state. Emerging biomarkers, including oleic acid chlorohydrin (OAC), intestinal fatty acid-binding protein (I-FABP), ischemia-modified albumin (IMA), and the GSTT-1*A polymorphism, also demonstrated prognostic value for disease severity and progression (p = 0.005 to < 0.001).

Oxidative stress and impaired antioxidant defences are consistently associated with increasing AP severity and adverse clinical outcomes. Several biomarkers demonstrate potential for early risk stratification. Although antioxidant therapies have previously been evaluated in AP, current findings remain heterogeneous and insufficient to establish clinical benefit, warranting further high-quality studies.