Journal
INTENSIVE CARE MEDICINE
Volume 37, Issue 5, Pages 808-815Publisher
SPRINGER
DOI: 10.1007/s00134-011-2153-0
Keywords
Selenium; Systemic inflammatory response syndrome; Sepsis; Organ failure; Glutathione peroxidase; C-reactive protein; Procalcitonin; Prealbumin; Antioxidants
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Systemic inflammatory response syndrome (SIRS) and sepsis remain the leading cause of death in the critically ill. A reduction in the antioxidant capacity, including selenoenzymes that are dependent on selenium (Se), could be a contributing factor. Se supplementation in septic patients have yielded conflicting results. We hypothesized that a high-dose Se supplementation would (1) improve markers of inflammation, nutrition and antioxidant defence, and (2) decrease mortality. This prospective, randomized, open-label, single-centre clinical trial included 150 patients with SIRS/sepsis and a SOFA score of > 5. Patients in the Se+ group (n = 75) received Se for 14 days (1,000 mu g on day 1,500 mu g/day on days 2-14). Patients in both the control (Se-) group (n = 75) and the Se+ group received a standard Se dose (< 75 mu g/day). Plasma Se, whole-blood glutathione peroxidase (GPx) activity, C-reactive protein (CRP), procalcitonin (PCT), albumin, prealbumin and cholesterol levels, along with APACHE II and SOFA scores, were determined at baseline and on days 1-7 and day 14. Mortality was assessed at day 28. Plasma Se and GPx activity were increased in the Se+ group from day 1 onwards. Negative correlations were demonstrated between plasma Se, CRP (P = 0.035), PCT (P = 0.022) and SOFA (P = 0.001) at admission but not on days 7 or 14. Prealbumin and cholesterol increased in the Se+ group versus the respective baselines. Mortality was similar between groups, with no gender differences. High-dose Se substitution in patients with SIRS/sepsis increased plasma Se and GPx levels, but did not reduce mortality. Markers of inflammation were reduced similarly in both groups.
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