Top

Critical Care

Published in:

Open Access 01-04-2014 | Research

Adjuvant selenium supplementation in the form of sodium selenite in postoperative critically ill patients with severe sepsis

Authors: Yasser Sakr, Vivian PL Maia, Clesar Santos, Julia Stracke, Mohamed Zeidan, Ole Bayer, Konrad Reinhart

Published in: Critical Care | Issue 2/2014

Abstract

Introduction

Plasma selenium (Se) concentrations are reduced in critically ill surgical patients, and lower plasma Se concentrations are associated with worse outcomes. We investigated whether adjuvant Se supplementation in the form of sodium selenite could improve outcomes in surgical patients with sepsis.

Methods

In this retrospective study, all adult patients admitted to a 50-bed surgical ICU with severe sepsis between January 2004 and April 2010 were included and analysed according to whether they had received adjuvant Se supplementation, which was given at the discretion of the attending physician. When prescribed, Se was administered in the form of sodium selenite pentahydrate (Na₂SeO₃∙5H₂O), in which 100 μg of Se corresponds to 333 μg of sodium selenite. A bolus of sodium selenite corresponding to 1,000 μg of Se was injected intravenously through a central venous line for 30 minutes, followed by infusion of 1,000 μg/day for 24 hours for 14 days until ICU discharge or death. We performed logistic regression analysis to investigate the impact of adjuvant Se supplementation on hospital mortality.

Results

Adjuvant Se was administered to 413 (39.7%) of the 1,047 patients admitted with severe sepsis. Age and sex were similar between patients who received adjuvant Se and those who did not. Compared with patients who did not receive adjuvant Se supplementation, patients who did had higher scores on the Simplified Acute Physiology Score II, a greater prevalence of cancer upon admission to the ICU and were more commonly admitted after abdominal surgery. Compared with patients who did not receive adjuvant Se, patients who did had higher hospital mortality rates (46% versus 39.1%; P = 0.027), and longer median (interquartile range (IQR)) ICU stays (15 days (6 to 24) versus 11 days (4 to 24); P = 0.01) and hospital lengths of stay (33 days (21 to 52) versus 28 days (17 to 46); P = 0.001). In multivariable analysis, adjuvant Se supplementation was not independently associated with favourable outcome (odds ratio = 1.19, 95% confidence interval = 0.86 to 1.65; P = 0.288).

Conclusions

In this retrospective analysis of a large cohort of surgical ICU patients with severe sepsis, adjuvant Se supplementation in the form of sodium selenite had no impact on in-hospital death rates after adjustment for confounders.

Sakr Y, Reinhart K, Bloos F, Marx G, Russwurm S, Bauer M, Brunkhorst F: Time course and relationship between plasma selenium concentrations, systemic inflammatory response, sepsis and multiorgan failure. Br J Anaesth 2007, 98: 775-784. 10.1093/bja/aem091CrossRefPubMed

Salama A, Sakr Y, Reinhart K: The role of selenium in critical illness: basic science and clinical implications. Indian J Crit Care Med 2007, 11: 127-138. 10.4103/0972-5229.35086CrossRef

Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies NA, Cooper CE, Singer M: Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet 2002, 360: 219-223. 10.1016/S0140-6736(02)09459-XCrossRefPubMed

Angstwurm MW, Engelmann L, Zimmermann T, Lehmann C, Spes CH, Abel P, Strauss R, Meier-Hellmann A, Insel R, Radke J, Schüttler J, Gärtner R: Selenium in Intensive Care (SIC): results of a prospective randomized, placebo-controlled, multiple-center study in patients with severe systemic inflammatory response syndrome, sepsis, and septic shock. Crit Care Med 2007, 35: 118-126. 10.1097/01.CCM.0000251124.83436.0ECrossRefPubMed

Manzanares W, Biestro A, Torre MH, Galusso F, Facchin G, Hardy G: High-dose selenium reduces ventilator-associated pneumonia and illness severity in critically ill patients with systemic inflammation. Intensive Care Med 2011, 37: 1120-1127. 10.1007/s00134-011-2212-6CrossRefPubMed

Berger MM, Reymond MJ, Shenkin A, Rey F, Wardle C, Cayeux C, Schindler C, Chioléro RL: Influence of selenium supplements on the post-traumatic alterations of the thyroid axis: a placebo-controlled trial. Intensive Care Med 2001, 27: 91-100. 10.1007/s001340000757CrossRefPubMed

Berger MM, Spertini F, Shenkin A, Wardle C, Wiesner L, Schindler C, Chioléro RL: Trace element supplementation modulates pulmonary infection rates after major burns: a double-blind, placebo-controlled trial. Am J Clin Nutr 1998, 68: 365-371.PubMed

Berger MM, Soguel L, Shenkin A, Revelly JP, Pinget C, Baines M, Chioléro RL: Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients. Crit Care 2008, 12: R101. 10.1186/cc6981PubMedCentralCrossRefPubMed

Andrews PJ, Avenell A, Noble DW, Campbell MK, Croal BL, Simpson WG, Vale LD, Battison CG, Jenkinson DJ, Cook JA, the SIGNET (Scottish Intensive care Glutamine or seleNium Evaluative Trial) Trials Group: Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients. BMJ 2011, 342: d1542. 10.1136/bmj.d1542CrossRefPubMed

10.

Forceville X, Laviolle B, Annane D, Vitoux D, Bleichner G, Korach JM, Cantais E, Georges H, Soubirou JL, Combes A, Bellissant E: Effects of high doses of selenium, as sodium selenite, in septic shock: a placebo-controlled, randomized, double-blind, phase II study. Crit Care 2007, 11: R73. 10.1186/cc5960PubMedCentralCrossRefPubMed

11.

Lindner D, Lindner J, Baumann G, Dawczynski H, Bauch K: [Investigation of antioxidant therapy with sodium selenite in acute pancreatitis: a prospective randomized blind trial] [in German]. Med Klin (Munich) 2004, 99: 708-712. 10.1007/s00063-004-1104-8CrossRef

12.

Valenta J, Brodska H, Drabek T, Hendl J, Kazda A: High-dose selenium substitution in sepsis: a prospective randomized clinical trial. Intensive Care Med 2011, 37: 808-815. 10.1007/s00134-011-2153-0CrossRefPubMed

13.

Kim IY, Stadtman TC: Inhibition of NF-κB DNA binding and nitric oxide induction in human T cells and lung adenocarcinoma cells by selenite treatment. Proc Natl Acad Sci U S A 1997, 94: 12904-12907. 10.1073/pnas.94.24.12904PubMedCentralCrossRefPubMed

14.

Jeong DW, Yoo MH, Kim TS, Kim JH, Kim IY: Protection of mice from allergen-induced asthma by selenite: prevention of eosinophil infiltration by inhibition of NF-κB activation. J Biol Chem 2002, 277: 17871-17876. 10.1074/jbc.M200808200CrossRefPubMed

15.

Kim TS, Yun BY, Kim IY: Induction of the mitochondrial permeability transition by selenium compounds mediated by oxidation of the protein thiol groups and generation of the superoxide. Biochem Pharmacol 2003, 66: 2301-2311. 10.1016/j.bcp.2003.08.021CrossRefPubMed

16.

Chung YW, Kim TS, Lee SY, Lee SH, Choi Y, Kim N, Min BM, Jeong DW, Kim IY: Selenite-induced apoptosis of osteoclasts mediated by the mitochondrial pathway. Toxicol Lett 2006, 160: 143-150. 10.1016/j.toxlet.2005.06.019CrossRefPubMed

17.

Forceville X: The effect of selenium therapy on mortality in patients with sepsis syndrome: simple selenium supplementation or real (5 H₂O)∙Na₂SeO₃ pharmacological effect? Crit Care Med 2013, 41: 1591-1592. 10.1097/CCM.0b013e31829106e5CrossRefPubMed

18.

Wang Z, Forceville X, Van Antwerpen P, Piagnerelli M, Ahishakiye D, Macours P, De Backer D, Neve J, Vincent JL: A large-bolus injection, but not continuous infusion of sodium selenite improves outcome in peritonitis. Shock 2009, 32: 140-146. 10.1097/SHK.0b013e318193c35dCrossRefPubMed

19.

Avenell A, Noble DW, Barr J, Engelhardt T: Selenium supplementation for critically ill adults. Cochrane Database Syst Rev 2004., 4: CD003703

20.

Heyland DK, Dhaliwal R, Suchner U, Berger MM: Antioxidant nutrients: a systematic review of trace elements and vitamins in the critically ill patient. Intensive Care Med 2005, 31: 327-337. 10.1007/s00134-004-2522-zCrossRefPubMed

21.

Manzanares W, Dhaliwal R, Jiang X, Murch L, Heyland DK: Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis. Crit Care 2012, 16: R66. 10.1186/cc11316PubMedCentralCrossRefPubMed

22.

Le Gall JR, Lemeshow S, Saulnier F: A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993, 270: 2957-2963. 10.1001/jama.1993.03510240069035CrossRefPubMed

23.

Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S: Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Crit Care Med 1998, 26: 1793-1800. 10.1097/00003246-199811000-00016CrossRefPubMed

24.

Panel on Dietary Antioxidants and Related Compounds, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of DRIs, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine: Selenium. In Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academy Press; 2000:284-324.

25.

European Commission, Health & Consumer Protection Directorate-General, Directorate C: Scientific Health Opinions, Unit C3; Management of Scientific Committees II: Opinion of the Scientific Committee on Food on the Tolerable Upper Intake Level of Selenium (SCF/CS/NUT/UPPLEV/25 Final Report). Brussels: European Commission; 28 November 2000. Available at (accessed 6 May 2014) http://ec.europa.eu/food/fs/sc/scf/out80g_en.pdf 28 November 2000. Available at (accessed 6 May 2014)

26.

American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992, 20: 864-874. 10.1097/00003246-199206000-00025CrossRef

27.

Zimmermann T, Albrecht S, Kühne H, Vogelsang U, Grützmann R, Kopprasch S: [Selenium administration in patients with sepsis syndrome: a prospective randomized study] [in German]. Med Klin (Munich) 1997, 92: 3-4.CrossRef

28.

Diplock AT: Antioxidants and disease prevention. Mol Aspects Med 1994, 15: 293-376. 10.1016/0098-2997(94)90005-1CrossRefPubMed

29.

Nève J: Selenium as a risk factor for cardiovascular diseases. J Cardiovasc Risk 1996, 3: 42-47. 10.1097/00043798-199602000-00006CrossRefPubMed

30.

Stewart MS, Spallholz JE, Neldner KH, Pence BC: Selenium compounds have disparate abilities to impose oxidative stress and induce apoptosis. Free Radic Biol Med 1999, 26: 42-48. 10.1016/S0891-5849(98)00147-6CrossRefPubMed

31.

Schomburg L: A large-bolus injection, but not continuous infusion of sodium selenite improves outcome in peritonitis. Shock 2010, 33: 554-556.PubMed

32.

Wang Z, Vincent JL, Forceville X: A large-bolus injection, but not continuous infusion of sodium selenite improves outcome in peritonitis. Shock 2010, 33: 555. 10.1097/01.shk.0000370605.53396.c1CrossRef

33.

Angstwurm MW, Schopohl J, Gaertner R: Selenium substitution has no direct effect on thyroid hormone metabolism in critically ill patients. Eur J Endocrinol 2004, 151: 47-54. 10.1530/eje.0.1510047CrossRefPubMed

34.

Mishra V, Baines M, Perry SE, McLaughlin PJ, Carson J, Wenstone R, Shenkin A: Effect of selenium supplementation on biochemical markers and outcome in critically ill patients. Clin Nutr 2007, 26: 41-50. 10.1016/j.clnu.2006.10.003CrossRefPubMed

35.

Angstwurm MW, Schottdorf J, Schopohl J, Gaertner R: Selenium replacement in patients with severe systemic inflammatory response syndrome improves clinical outcome. Crit Care Med 1999, 27: 1807-1813. 10.1097/00003246-199909000-00017CrossRefPubMed

36.

Kuklinski B, Buchner M, Schweder R, Nagel R: [Acute pancreatitis—a free radical disease: decrease in fatality with sodium selenite (Na₂SeO₃) therapy] [in German]. Z Gesamte Inn Med 1991, 46: 145-149.PubMed

37.

Olson OE: Selenium toxicity in animals with emphasis on man. Int J Toxicol 1986, 5: 45-70. 10.3109/10915818609140736CrossRef

Title: Adjuvant selenium supplementation in the form of sodium selenite in postoperative critically ill patients with severe sepsis
Authors: Yasser Sakr
Vivian PL Maia
Clesar Santos
Julia Stracke
Mohamed Zeidan
Ole Bayer
Konrad Reinhart
Publication date: 01-04-2014
Publisher: BioMed Central
Published in: Critical Care / Issue 2/2014
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc13825

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Adjuvant selenium supplementation in the form of sodium selenite in postoperative critically ill patients with severe sepsis

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2014

Management of Pseudomonas aeruginosa pneumonia: one size does not fit all

Pharmacokinetics of anidulafungin during albumin dialysis

Predictors of physical restraint use in Canadian intensive care units

Thoracic ultrasonography versus chest radiography for detection of pneumothoraces: challenges in deriving and interpreting summary diagnostic accuracy estimates

Is pharmacological, H2S-induced 'suspended animation' feasible in the ICU?

Evaluating mortality in an intensive care unit requires extended survival models