Oxidative stress results from an oxidant/antioxidant imbalance. Oxidative stress plays an important role in the pathogenesis of lung diseases. This study was done to investigate whether oxidative stress is increased in critically ill patients on mechanical ventilation and if any correlation exits in the level of C-reactive protein (an inflammatory marker) and burden of oxidative stress as measured by serum malondialdehyde (MDA) levels.
Critically ill patients (mean age 60.20 ± 12.10 years) with acute exacerbation of COPD admitted to the ICU were studied. We evaluated twenty eight patients who died and twenty eight who survived. Serum MDA level was measured by enzyme-linked immunosorbent assay. Concentration of serum CRP was measured by Latex enhanced immunoturbidimetry method. Written informed consent was obtained from relatives of the patients. The study was approved by the ethics committee of the Institute.
In all the patients studied MDA (normal range 1.86–3.94 αM )and CRP (normal range 0- 0.3 mg/dl)level were significantly higher than the normal range. Median (interquartile range) level of MDA ( on admission) in patients who died and survived was 20.56 (12.12–34.21) μM and 11.57 (7.40–18.13) μM respectively. The difference in the level of MDA in the two groups was significant (P < .011). Median (interquartile range) level of CRP (on admission) in patients who died was 11.65 (7.10–23.07) mg/dl and it was 5.60 (3.32–10.25) mg/dl in those who survived. The difference in the concentration of CRP in the two groups was also significant (P < .013).
In critically ill patients admitted to the ICU increased oxidative stress and CRP level correlated with the mortality.
Increased oxidative stress and inflammation is associated with mortality in critically ill patients. Patients with raised baseline MDA and C-reactive protein levels need aggressive management as these patients have a higher mortality.
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