Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Dig Surg 2007;24:331–337 DOI: 10.1159/000106511 Free Radical and Antioxidant Levels in Patients with Secondary Peritonitis and Their Prognostic Significance Yogesh Kumar a Gurpreet Singh b Brian R. Davidson a a University Department of Surgery, Royal Free Hospital, Royal Free and University College Medical School, UCL, London, UK; b Department of Surgery, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India (r = 0.477, p ! 0.01), catalase (r = –0.489, p ! 0.01) and SOD (r = –0.357, p ! 0.05). Admission superoxide levels were higher and antioxidant levels lower in peritonitis patients than controls. Levels did not significantly change following surgical intervention and post-operative levels did not cor- relate with outcome. Conclusion: The levels of superoxide and antioxidants correlate with the severity of illness on ad- mission in patients with secondary peritonitis, but serial lev- els following surgical intervention do not predict outcome. Copyright © 2007 S. Karger AG, Basel Introduction Generalised peritonitis is associated with a high mor- bidity and mortality (11–29%) despite significant ad- vances in diagnosis and treatment by surgery, antibiotic therapy and intensive care support [1–3]. Mortality is particularly high in the elderly and can be accurately determined using the APACHE II score [1, 4, 5]. Mortal- ity usually results from persistent or recurrent intra-ab- dominal infection, systemic sepsis or multi-system or- gan failure (MSOF) [6, 7] . Early surgical intervention and antibiotic therapy are essential, but the outcome is largely dependent on the individual’s ability to with- Key Words Secondary peritonitis  APACHE II  Superoxides  Antioxidants  Catalase  Superoxide dismutase  Glutathione peroxidase Abstract Background: The clinical outcome of patients with second- ary bacterial peritonitis depends on the production of super- oxides involved in bacterial killing and the endogenous lev- el of antioxidants. The prognostic significance of their levels has not previously been investigated. Patients and Meth- ods: Forty-five patients undergoing surgery for secondary peritonitis were prospectively evaluated. Severity of illness at admission (APACHE II score) was correlated with admis- sion levels of superoxide radicals and antioxidants (superox- ide dismutase (SOD), catalase and glutathione peroxidase). Levels were compared with general surgery controls (n = 10). Superoxide and antioxidant levels at admission (day 1) and post-operative days 3 and 5/7 were then correlated with out- come. Results: Nine of the 45 patients died (20% mortality) and 17 patients had complications (47% morbidity). The mean APACHE II score on admission was significantly higher among non-survivors than survivors (p ! 0.01). The APACHE II score on admission correlated with the level of free radicals Received: August 14, 2006 Accepted: January 29, 2007 Published online: July 27, 2007 Prof. Brian R. Davidson Department of Surgery, Royal Free Hospital Royal Free and University College Medical School University College London, London NW3 2QG (UK) Tel. +44 20 7830 2757, Fax +44 20 7830 2688, E-Mail b.davidson@medsch.ucl.ac.uk © 2007 S. Karger AG, Basel 0253–4866/07/0245–0331$23.50/0 Accessible online at: www.karger.com/dsu