Selenium, Vitamin C and N-Acetylcysteine do not Reduce the Risk of Acute Kidney Injury after Off-Pump CABG: a Randomized Clinical Trial

Amini, Shahram; Robabi, Hojat Naghavi; Tashnizi, Mohammad Abbasi; Vakili, Vida

doi:10.21470/1678-9741-2017-0071

Cited by 38 publications

(47 citation statements)

References 32 publications

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“…The proportion of males varied from 58% to 75%. Five trials were carried out in Iran [12,13,15,18,19], two in Egypt [14,16], one in the USA [11], and one in Japan [17]. For detailed descriptions of the trials, see Additional file 1: Table S1.…”

Section: Results Of the Included Trialsmentioning

confidence: 99%

“…For detailed descriptions of the trials, see Additional file 1: Table S1. The Amini trial [12] results are modified as described previously [1] *Estimated vitamin C dose, see the "Methods" section **Sadeghpour et al [19] recruited 500 participants but reported the results for just 290 participants [1]. Because of the high dropout rate (42%), we did not include this trial in our calculations, but we overlay the findings in Fig.…”

Section: Results Of the Included Trialsmentioning

confidence: 99%

“…To explain this association by publication bias would require that positive studies with less ill patients remain unpublished, and negative studies with severely ill patients also remain unpublished. Five trials did not use an explicit placebo [12][13][14][15]17], but we do not consider that the lack of placebo undermines the validity of those trials, since ICU patients receive numerous treatments and it is unlikely that one additional tablet or infusion would cause a substantial placebo effect for ventilated patients. The lack of a placebo may cause bias in research on subjective outcomes, but less so on objective outcomes [52].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, we perused the reference lists of the selected trials and relevant reviews, from which we discovered two more trials. We identified nine trials satisfying our selection criteria [11][12][13][14][15][16][17][18][19]. We did not include two further trials that reported "ventilator-free days" since we were unable to convert this to our outcome of interest, "duration of mechanical ventilation" [20,21].…”

Section: Methodsmentioning

confidence: 99%

“…Thus, we The searches were carried out on 13 Nov 2019. The searches identified nine trials that we included in our systematic review analysis [11][12][13][14][15][16][17][18][19] and eight of them were included in our meta-analysis [11][12][13][14][15][16][17][18] calculated that the average dose was 90 g/day in the Tanaka trial. Zabet et al administered 25 mg/kg every 6 h, but the mean weight was not reported [18].…”

Section: Methodsmentioning

confidence: 99%

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Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis

2020

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Background: Our recent meta-analysis indicated that vitamin C may shorten the length of ICU stay and the duration of mechanical ventilation. Here we analyze modification of the vitamin C effect on ventilation time, by the control group ventilation time (which we used as a proxy for severity of disease in the patients of each trial). Methods: We searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials and reference lists of relevant publications. We included controlled trials in which the administration of vitamin C was the only difference between the study groups. We did not limit our search to randomized trials and did not require placebo control. We included all doses and all durations of vitamin C administration. One author extracted study characteristics and outcomes from the trial reports and entered the data in a spreadsheet. Both authors checked the data entered against the original reports. We used meta-regression to examine whether the vitamin C effect on ventilation time depends on the duration of ventilation in the control group.Results: We identified nine potentially eligible trials, eight of which were included in the meta-analysis. We pooled the results of the eight trials, including 685 patients in total, and found that vitamin C shortened the length of mechanical ventilation on average by 14% (P = 0.00001). However, there was significant heterogeneity in the effect of vitamin C between the trials. Heterogeneity was fully explained by the ventilation time in the untreated control group. Vitamin C was most beneficial for patients with the longest ventilation, corresponding to the most severely ill patients. In five trials including 471 patients requiring ventilation for over 10 h, a dosage of 1-6 g/day of vitamin C shortened ventilation time on average by 25% (P < 0.0001). Conclusions: We found strong evidence that vitamin C shortens the duration of mechanical ventilation, but the magnitude of the effect seems to depend on the duration of ventilation in the untreated control group. The level of baseline illness severity should be considered in further research. Different doses should be compared directly in future trials.

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Section: Results Of the Included Trialsmentioning

confidence: 99%

Section: Results Of the Included Trialsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis

2020

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Effect of High-Dose Selenium on Postoperative Organ Dysfunction and Mortality in Cardiac Surgery Patients

et al. 2023

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ImportanceSelenium contributes to antioxidative, anti-inflammatory, and immunomodulatory pathways, which may improve outcomes in patients at high risk of organ dysfunctions after cardiac surgery.ObjectiveTo assess the ability of high-dose intravenous sodium selenite treatment to reduce postoperative organ dysfunction and mortality in cardiac surgery patients.Design, Setting, and ParticipantsThis multicenter, randomized, double-blind, placebo-controlled trial took place at 23 sites in Germany and Canada from January 2015 to January 2021. Adult cardiac surgery patients with a European System for Cardiac Operative Risk Evaluation II score–predicted mortality of 5% or more or planned combined surgical procedures were randomized.InterventionsPatients were randomly assigned (1:1) by a web-based system to receive either perioperative intravenous high-dose selenium supplementation of 2000 μg/L of sodium selenite prior to cardiopulmonary bypass, 2000 μg/L immediately postoperatively, and 1000 μg/L each day in intensive care for a maximum of 10 days or placebo.Main Outcomes and MeasuresThe primary end point was a composite of the numbers of days alive and free from organ dysfunction during the first 30 days following cardiac surgery.ResultsA total of 1416 adult cardiac surgery patients were analyzed (mean [SD] age, 68.2 [10.4] years; 1043 [74.8%] male). The median (IQR) predicted 30-day mortality by European System for Cardiac Operative Risk Evaluation II score was 8.7% (5.6%-14.9%), and most patients had combined coronary revascularization and valvular procedures. Selenium did not increase the number of persistent organ dysfunction–free and alive days over the first 30 postoperative days (median [IQR], 29 [28-30] vs 29 [28-30]; P = .45). The 30-day mortality rates were 4.2% in the selenium and 5.0% in the placebo group (odds ratio, 0.82; 95% CI, 0.50-1.36; P = .44). Safety outcomes did not differ between the groups.Conclusions and RelevanceIn high-risk cardiac surgery patients, perioperative administration of high-dose intravenous sodium selenite did not reduce morbidity or mortality. The present data do not support the routine perioperative use of selenium for patients undergoing cardiac surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT02002247

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Reactive oxygen species, toxicity, oxidative stress, and antioxidants: chronic diseases and aging

Jomova,

Raptova,

Alomar

et al. 2023

Arch Toxicol

513

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A physiological level of oxygen/nitrogen free radicals and non-radical reactive species (collectively known as ROS/RNS) is termed oxidative eustress or “good stress” and is characterized by low to mild levels of oxidants involved in the regulation of various biochemical transformations such as carboxylation, hydroxylation, peroxidation, or modulation of signal transduction pathways such as Nuclear factor-κB (NF-κB), Mitogen-activated protein kinase (MAPK) cascade, phosphoinositide-3-kinase, nuclear factor erythroid 2–related factor 2 (Nrf2) and other processes. Increased levels of ROS/RNS, generated from both endogenous (mitochondria, NADPH oxidases) and/or exogenous sources (radiation, certain drugs, foods, cigarette smoking, pollution) result in a harmful condition termed oxidative stress (“bad stress”). Although it is widely accepted, that many chronic diseases are multifactorial in origin, they share oxidative stress as a common denominator. Here we review the importance of oxidative stress and the mechanisms through which oxidative stress contributes to the pathological states of an organism. Attention is focused on the chemistry of ROS and RNS (e.g. superoxide radical, hydrogen peroxide, hydroxyl radicals, peroxyl radicals, nitric oxide, peroxynitrite), and their role in oxidative damage of DNA, proteins, and membrane lipids. Quantitative and qualitative assessment of oxidative stress biomarkers is also discussed. Oxidative stress contributes to the pathology of cancer, cardiovascular diseases, diabetes, neurological disorders (Alzheimer’s and Parkinson’s diseases, Down syndrome), psychiatric diseases (depression, schizophrenia, bipolar disorder), renal disease, lung disease (chronic pulmonary obstruction, lung cancer), and aging. The concerted action of antioxidants to ameliorate the harmful effect of oxidative stress is achieved by antioxidant enzymes (Superoxide dismutases-SODs, catalase, glutathione peroxidase-GPx), and small molecular weight antioxidants (vitamins C and E, flavonoids, carotenoids, melatonin, ergothioneine, and others). Perhaps one of the most effective low molecular weight antioxidants is vitamin E, the first line of defense against the peroxidation of lipids. A promising approach appears to be the use of certain antioxidants (e.g. flavonoids), showing weak prooxidant properties that may boost cellular antioxidant systems and thus act as preventive anticancer agents. Redox metal-based enzyme mimetic compounds as potential pharmaceutical interventions and sirtuins as promising therapeutic targets for age-related diseases and anti-aging strategies are discussed.

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Selenium, Vitamin C and N-Acetylcysteine do not Reduce the Risk of Acute Kidney Injury after Off-Pump CABG: a Randomized Clinical Trial

Cited by 38 publications

References 32 publications

Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis

Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis

Effect of High-Dose Selenium on Postoperative Organ Dysfunction and Mortality in Cardiac Surgery Patients

Reactive oxygen species, toxicity, oxidative stress, and antioxidants: chronic diseases and aging

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