Document Type : Original Article
Authors
1 Department Of Anaesthesiology And Critical Care, Faculty Of Anaesthesia, Pt. B.D Sharma University Of Health Sciences Rohtak, Haryana, 124001, India.
2 PT. B. D. Sharma, UHS, Rohtak, Haryana, India
3 1Department Of Anaesthesiology And Critical Care, Pt. B.D Sharma University Of Health Sciences Rohtak, Haryana, 124001, India.
4 Department Of Anaesthesiology And Critical Care, Senior Resident of critical care, AIIMS, New Delhi,110029 India.
Abstract
Background:
Sepsis and systemic inflammatory response syndrome continue to be leading causes of death in critically ill patients. These conditions are characterized by elevated oxidative stress and diminished levels of antioxidants. Selenium (Se), a micronutrient, plays crucial roles in antioxidation, inflammation suppression, and immune function, making it pivotal in combating oxidative stress and supporting overall health in such patients. This study aims to assess the impact of intravenous selenium supplementation on sequential organ failure assessment score (SOFA) and to investigate selenium's potential as a biomarker in critically ill patients.
Patients and Methods: Fifty-five critically ill patients received intravenous Se at a dosage of 600 micrograms daily for three consecutive days. Clinical parameters including SOFA score, ICU and hospital stays, and duration of mechanical ventilation and biochemical parameters such as C-reactive protein (CRP), Interleukin-6 (IL 6), Se levels, and total leukocyte count (TLC) were assessed before Se administration and on the fifth day post-administration for analysis.
Results: After administering Se injections, there was a significant increase in serum Se concentrations from 195.45±64.03 to 295.45±87.81 “p <0.001”. Additionally, a notable decrease in SOFA score was observed, dropping from 7.21 to 6.41 “p = 0.004”. Furthermore, CRP levels showed a statistically significant decrease following Se administration.
Conclusions: Our study findings demonstrate significant improvements in SOFA score and CRP levels among the patients. Se supplementation significantly boosts plasma Se levels, thereby enhancing tissue Antioxidant Capacity inThese Patients
Keywords
Main Subjects
1. Brodska H, Valenta J, Malickova K, Kohout P, Kazda A, Drabek T. Biomarkers in critically ill patients with systemic inflammatory response syndrome or sepsis supplemented with high-dose selenium. J Trace Elem Med Biol 2015;31:25-32.
https://doi.org/10.1016/j.jtemb.2015.02.005
2. Lovat, Robin MD, Jeans Chsrles MD. Antioxidant therapy in intensive care. Current Opinion in Critical Care 2003;9:266-70. https://doi.org/10.1097/00075198-200308000-00003
3. Manzanares W, Biestro A, Torre MH, Galusso F, Facchin G, Hardy G. High dose selenium reduces ventilator associated pneumonia and illness severity in critical ill patients with systemic inflammation. Intensive Care Med 2011;37:1120-7. https://doi.org/10.1007/s00134-011-2212-6
4. Broman LM, Bernardson A, Bursell K, Wernerman J, Flaring U, Tjader I. Serum selenium in critically ill patients: Profile and supplementation in a depleted region. Acta Anesthesiol Scand 2020;64:803-9.
https://doi.org/10.1111/aas.13573
5. Kipp AP, Sttrohm D, Brigelius- Flohe R, Schomburg L, Bechthold A, Leschik-Bonnet E, et al. Revised reference values for selenium intake. J Trace Elem Med Biol 2015;32:195-9.
https://doi.org/10.1016/j.jtemb.2015.07.005
6. Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, et al. Association between mitochondrial dysfunction and severity and outcome of septic shock. The Lancet 2002;360:219-23.
https://doi.org/10.1016/S0140-6736(02)09459-X
7. Mahmoodpoor A, Faramarzi E, Reyhanifard A, Shamekh A, Zeinalhajlou A5. The effects of selenium supplementation on inflammatory markers in critically ill patients. SN Applied sciences 2022;4:326.
https://doi.org/10.1007/s42452-022-05208-4
8. Forceville X, Laviolle B, Annane D, Vitoux D, Bleichner G, Korach JM, et al. 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. https://doi.org/10.1186/cc5960
9. Mishra V, Baines M, Elizabeth Perry S, Jeremy mclaughlin P, Carson J, Wenstone R, et al. Effect of selenium supplementation on biochemical markers and outcome in critically ill patients. Clin Nutr 2007;26:41-50. https://doi.org/10.1016/j.clnu.2006.10.003
10. Chelkeba L, Ahmadi A, Abdollahi M, Najafi A, Ghadimi MH, Mosaed R, et al. The effect of parenteral selenium on outcomes of mechanically ventilated patients following sepsis: a prospective randomized clinical trial. Ann Intensive Care 2015; 5:29. https://doi.org/10.1186/s13613-015-0071-y
11. Angstwurm MWA, Engelmann L, Zimmermann T, Lehmann C, Spes CH, Abel P, et al. 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;35:118-26.
https://doi.org/10.1097/01.CCM.0000251124.83436.0E
12. Quintana HL, Lorente VH, López MJ, Planells E, et al. Selenium levels and antioxidant activity in critically ill patients with systemic inflammatory response syndrome. Metabolites 2022;12:274.
https://doi.org/10.3390/metabo12040274
13. Mahmoodpoor A, Hamishekhar H, Shadvar K,Ostadi Z, Sonaie S, Saghaleini S et al. The effect of intravenous selenium on oxidative stress in critically ill patients with acute respiratory distress syndrome. Immunol Invest 2019;48:147-159.
https://doi.org/10.1080/08820139.2018.1496098
14. 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;37:808-15.
https://doi.org/10.1007/s00134-011-2153-0