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

Abstract

IntroductionPlasma 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.MethodsIn 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.ResultsAdjuvant 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).ConclusionsIn 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.

Preserved Expression of mRNA Coding von Willebrand Factor-Cleaving Protease ADAMTS13 by Selenite and Activated Protein C

“…In accordance with these observations, our findings suggest that ADAMTS13 deficiency during systemic inflammation and infection accelerate inflammatory responses by slowing down leukocytes and facilitating their extravasation, which functions intrinsically as a protective mechanism, but becomes destructive due to an overwhelming systemic response which might be limited by APC. In septic patients, the role of selenite supplementation to modulate reactive oxygen species generation, lower endogenous antioxidative capacity and improve clinical outcome is controversial (66)(67)(68). Here, we demonstrate that selenite abrogates the inhibitory effect of serum constituents from septic patients on cultivated HSCs and endothelial cells.…”

Adjuvante Therapie der Sepsis

“…Diese Ergebnisse wurden aber nicht bestä-tigt [46]. Das Fehlen einer sig nifikanten Reduktion des Sterberisikos von Sepsispatienten durch Selensupplementierung wurde auch in aktualisierten Metaanalysen [47] und in einer rezenten Beobachtungsstudie [48] bestätigt.…”

Carga de trabalho do nutricionista clínico: estudo de tempo e movimento contínuo em unidades de internação hospitalar

“…Diversas pesquisas científicas apontam que a evolução clínica dos pacientes internados depende da adequada ingestão de água, energia e nutrientes (20)(21)(22)(23)(24)(25)(26)(27)(28)(29) .…”