Intravenous n-acetylcysteine, ascorbic acid and selenium-based anti-oxidant therapy in severe acute pancreatitis

Scand J Gastroenterol. 2003 Dec;38(12):1262-7. doi: 10.1080/00365520310006540.


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.

Publication types

  • Clinical Trial

MeSH terms

  • Acetylcysteine / administration & dosage*
  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antioxidants / administration & dosage*
  • Antioxidants / adverse effects
  • Antioxidants / metabolism
  • Ascorbic Acid / administration & dosage*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Oxidative Stress
  • Pancreatitis / drug therapy*
  • Pancreatitis / metabolism
  • Pancreatitis / mortality
  • Selenium / administration & dosage*
  • Survival Rate
  • alpha-Tocopherol / administration & dosage
  • beta Carotene / administration & dosage


  • Antioxidants
  • beta Carotene
  • alpha-Tocopherol
  • Selenium
  • Ascorbic Acid
  • Acetylcysteine