The role of thiol/disulfide hemostasis in the diagnosis and severity prediction of acute pancreatitis

Objective: Reactive oxygen radicals are generated in the early stages of acute pancreatitis (AP) and are responsible for its progression. Thiol/disulfide homeostasis (TDH) is an important antioxidative mechanism. This study aimed to evaluate the role of TDH in the differential diagnosis of AP and predict its clinical severity.  Methods: Patients admitted to the emergency department due to upper abdominal pain were evaluated. The study consisted of two groups: the AP group and the non-AP group (patients with diagnoses other than AP). The AP group was divided into mild and severe according to Acute physiology and chronic health evaluation II (APACHE-II) scores. TDH was measured with an automated assay from Erel et al. Statistical analyses were done with SPSS 16.0. Results: The results from 128 cases—58 in the AP group and 70 in the non-AP group—were evaluated. There was no difference in TDH parameters between the AP and non-AP groups. Among the AP subgroups, native thiol (sh) and total thiol (tt) were significantly lower in the severe AP group (sh: 313.9 μmol/L, 239.1 μmol/L; tt: 351.5 μmol/L, 303 μmo/L, respectively, in the mild and severe AP groups, P-value=0.006, P-value=0.013). Conclusion: TDH parameters change because of inflammatory processes in AP. Since this change does not occur for any specific reason, using TDH parameters for differential diagnosis of AP in patients with upper abdominal pain is not appropriate. However, in patients already diagnosed with AP, native and total thiol levels might be helpful in the prediction of clinical severity with a limited role.