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The purpose of this pilot study was to evaluate the correlation between clinical severity and serum oxygen radical activity (ORA) and total antioxidation capacity (TAC) in critically ill surgical patients with sepsis.The prospective observational study was performed in surgical intensive care unit (SICU) patients with intra-abdominal sepsis. Serum ORA and TAC levels were measured using a spectrophotometry-based antioxidant assay machine. Serum selenium and zinc levels and plasma glutamine concentrations were also determined. Sequential organ failure assessment (SOFA) and multiple organ dysfunction (MOD) scores were calculated to evaluate the severity. Blood tests and severity scores were assessed on days 1, 3, and 7 in the SICU.Twenty-seven patients were included. The mean APACHE II score was 22.4. The in-hospital mortality rate was 14.8%. Serum TAC levels correlated positively with SOFA and MOD scores on SICU days 1, 3 and 7, and serum ORA correlated negatively with SOFA and MOD scores on day 3. Serum zinc and selenium levels were lower than normal throughout the observation period. However, there was no significant relationship in clinical severity.Serum TAC level may be a useful biomarker to predict severity of critically ill surgical patients with sepsis.Serum TAC levels correlated positively with sepsis severity on SICU day 1, 3, and 7.Serum ORA correlated negatively with SOFA and MODS scores on day 3.TAC level of SICU day 1, 3, and 7 was significantly higher in non-survivors than in survivors.