Effect of necrosectomy and vacuum-assisted closure (VAC) on mitochondrial function and oxidative stress markers in severe acute pancreatitis

• Published in: Revista española de enfermedades digestivas Vol. 106; no. 8; pp. 505 - 514
• Main Authors: Miranda-Díaz, Alejandra Guillermina, Hermosillo-Sandoval, José Manuel, Gutiérrez-Martínez, Carlos Alberto, Rodríguez-Carrizalez, Adolfo Daniel, Román-Pintos, Luis Miguel, Cardona-Muñoz, Ernesto Germán, Pacheco-Moisés, Fermín Paul, Arias-Carvajal, Óscar
• Format: Journal Article
• Language: English
• Published: Spain Sociedad Española de Patología Digestiva 01.12.2014; Aran Ediciones
• Subjects: Adult; Antioxidants; Disfunción mitocondrial; Estrés oxidativo; Female; Gastroenterology & Hepatology; Geriatrics & Gerontology; Humans; Infectious Diseases; Male; Membrane Fluidity; Middle Aged; Mitochondria - metabolism; Oncology; Oxidative Stress; Pancreatectomy - methods; Pancreatitis - metabolism; Pancreatitis - surgery; Pancreatitis aguda; Pancreatitis aguda severa; Pathology; Pharmacology & Pharmacy; Prospective Studies; Radiology, Nuclear Medicine & Medical Imaging; Surgery; Vacuum; Wound Closure Techniques; Pancreatitis aguda; Oxidative stress; Acute pancreatitis; Mitochondrial dysfunction; Severe acute pancreatitis; Pancreatitis aguda severa; Disfunción mitocondrial; Estrés oxidativo
• ISSN: 1130-0108

Severe acute pancreatitis (SAP) is associated with high morbidity and mortality. To evaluate whether necrosectomy, alone or combined with vacuum-assisted closure (VAC), has any additional beneficial effects on mitochondrial function and/or oxidative stress markers in SAP. Patients with SAP, APACHE II score > 8, and inadequate response to management in an intensive care unit were included in a prospective observational study. Sixteen underwent necrosectomy and 24 underwent necrosectomy plus VAC every 48 h. Patients were then categorized as survivors or deceased. Submitochondrial membrane fluidity of platelets and F0F1-ATPase hydrolysis were measured to represent mitochondrial function. Oxidative/nitrosative stress was measured using lipoperoxides (LPOs), nitric oxide (NO), erythrocyte membrane fluidity, and total antioxidant capacity (TAC). Membrane fluidity in submitochondrial particles of platelets remained significantly increased throughout the study, and then eventually rised in deceased patients managed with necrosectomy + VAC vs. survivors (p < 0.041). Hydrolysis was significantly increased from baseline to endpoint in all patients, predominating in those who died after management with necrosectomy (p < 0.03). LPO increased in all patients, and necrosectomy was more efficient for the eventual decrease in survivors (p < 0.039). NO was found to be increased for the baseline-endpoint result among both survivors and deceased patients with both management options. Erythrocyte membrane fluidity was increased in survivors managed with necrosectomy + VAC, and eventually returned to normal (p < 0.045). TAC was found to be consumed in all patients for the duration of the study. Mitochondrial dysfunction and oxidative/ nitrosative stress with significant systemic antioxidant consumption were found. Necrosectomy was more efficient and better cleared LPOs. Necrosectomy + VAC improved erythrocyte membrane fluidity and increased survival.