Clinical Significance of Serum Nitric Oxide, Urine Nitric Oxide, and Urinary Nitric Oxide-to-Creatinine Ratio in Acute Pancreatitis

To estimate the serum nitric oxide (NO), urine nitric oxide level, and urinary nitric oxide-to-creatinine ratio in patients with acute pancreatitis and to correlate it with the established severity markers of pancreatitis, like C-reactive protein (CRP), APACHE II score, and CT severity index (CTSI). Thirty cases of acute pancreatitis, presenting within 72 h of onset of pain were included in the study and their serum NO level, urine NO level, and urinary nitric oxide-to-creatinine ratio was assessed. Another 15 cases were included as controls. The patients were followed until discharge and the complications, organ failure, and interventions required were noted. Patients with acute pancreatitis had statistically significant increase in the levels of serum NO and urine nitric oxide-to-creatinine ratio compared to control patients (p = 0.001). Serum NO, urine NO, and urine NO-to-creatinine ratio were lower in patients with severe pancreatitis. Patients with collection, pleural effusion, and organ failure had lower levels of serum and urine NO and urine NO-to-creatinine ratio. Patients with pancreatic necrosis had higher level of serum NO. Patients who needed percutaneous drain (PCD)/surgery or those who died had lower levels of serum and urine NO and urine NO-to-creatinine ratio. Only urine NO level had a negative correlation with CRP levels, APACHE II score, and CTSI. Patients with acute pancreatitis had statistically significant increase in levels of serum nitric oxide and urine nitric oxide-to-creatinine ratio, compared to controls. Serum nitric oxide and urine nitric oxide-to-creatinine ratio does not help in assessing severity of acute pancreatitis.