Serum trace elements levels in patients transferred from the intensive care unit to wards

Gündoğan, Kürşat; Özer, Nurhayat Tuğra; Şahįn, Gülşah; Mendil, Nilgun Ozlem Alptekinoglu; Şahin, Serap; Temel, Şahin; Guven, Muhammet; Sungur, Murat

doi:10.1016/j.clnesp.2021.06.014

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…In reference to Se support, the average amount was less than 40.0 µg of Se per day, which is clearly lower than the Dietary Recommended Values for the healthy adult European population (70.0 µg Se/day) [28] or the suggested Se doses in ICU patients [27]. Our results are consistent with those of other studies, where similar plasma Se levels were found in patients transferred from the ICU to wards [29] and where enteral nutrition did not normalize the plasma levels in the first week of ICU stay [6]. The critically ill patients in our study just received a standard formula with no special supplementation during their ICU stay, and the prevalence of patients with a risk of deficiency increased over time.…”

Section: Discussionsupporting

confidence: 88%

Selenium Levels and Antioxidant Activity in Critically Ill Patients with Systemic Inflammatory Response Syndrome

et al. 2022

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The Selenium (Se) status could be an important modifiable factor in critically ill patient outcomes due to the important role of this mineral in several functions. Although there are many clinical trials with Se interventions in the literature, the evidence is not sufficient to establish a common criterion regarding the Se status. Background and aims: An analysis was made of the evolution of selenium (Se) and antioxidant status in critically ill patients with Systemic Inflammatory Response Syndrome (SIRS) over 7 days of staying in the Intensive Care Unit (ICU). Methods: A prospective analytical study was carried out on 65 critically ill patients aged 31–77 years. A healthy control group of 56 volunteers from the same region was recruited to allow comparisons with reference normal values. The selenium levels in both the plasma and erythrocytes were analyzed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Glutathione Peroxidase (GPx) and Superoxide Dismutase (SOD) activity and the Total Antioxidant Capacity (TAC) were measured using kinetic colorimetric methods. Results: Low erythrocyte and plasma Se levels were found at ICU admission in comparison with the healthy reference group (p < 0.001), and the levels further decreased after one week (p < 0.001). Smaller changes in the plasma Se levels were associated with greater changes in the Sequential Organ Failure Assessment (SOFA) score (p < 0.05). The GPx activity in the critically ill was lower than in the control group (p < 0.05), with an inverse correlation to the severity scores at the baseline (p < 0.05) and reaching normal values after one week (p < 0.05). SOD activity was directly correlated to TAC (p = 0.03), with both parameters exhibiting a direct correlation to albumin (p < 0.05) after 7 days of ICU stay. Conclusions: A deficient Se status was observed at ICU admission and worsened further over follow-up regardless of the evolution of the patient severity and the antioxidant parameters. Adequate Se support from the start of admission could preserve and contribute to improve the Se-related outcomes and critical patient recovery during longer periods in the ICU.

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Section: Discussionsupporting

confidence: 88%

Selenium Levels and Antioxidant Activity in Critically Ill Patients with Systemic Inflammatory Response Syndrome

et al. 2022

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“…The status at discharge from the ICU was investigated in 100 patients (median stay of 5 days), most being still inflammatory with a median CRP of 54 mg/l [10]: serum concentrations of chromium, zinc and selenium were lower than the reference values in 98, 90 and 36% of patients, respectively. The 28-day ICU mortality was correlated with low serum selenium levels ( P = 0.03).…”

Section: Micronutrient Status and Intakementioning

confidence: 99%

An update on essential micronutrients in critical illness

Berger

2023

Current Opinion in Critical Care

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Purpose of review Numerous micronutrients are involved in antioxidant and immune defence, while their blood concentrations are frequently low in critically ill patients: this has fuelled many supplementation trials. Numerous observational, randomized studies have been published, which are presented herein. Recent findings Micronutrient concentrations must be analysed considering the context of the inflammatory response in critical illness. Low levels do not always indicate a deficiency without objective micronutrients losses with biological fluids. Nevertheless, higher needs and deficiencies are frequent for some micronutrients, such as thiamine, vitamins C and D, selenium, zinc and iron, and have been acknowledged with identifying patients at risk, such as those requiring continuous renal replacement therapy (CRRT). The most important trials and progress in understanding have occurred with vitamin D (25(OH)D), iron and carnitine. Vitamin D blood levels less than 12 ng/ml are associated with poor clinical outcomes: supplementation in deficient ICU patients generates favourable metabolic changes and decreases mortality. Single high-dose 25(OH)D should not be delivered anymore, as boluses induce a negative feedback mechanism causing inhibition of this vitamin. Iron-deficient anaemia is frequent and can be treated safely with high-dose intravenous iron under the guidance of hepcidin to confirm deficiency diagnosis. Summary The needs in critical illness are higher than those of healthy individuals and must be covered to support immunity. Monitoring selected micronutrients is justified in patients requiring more prolonged ICU therapy. Actual results point towards combinations of essential micronutrients at doses below upper tolerable levels. Finally, the time of high-dose micronutrient monotherapy is probably over.

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“…Micronutrients are essential components as cofactors of enzymes critical for numerous metabolic processes and immunological and antioxidant functions. In critical illness, micronutrient deficiencies are common, potentially because of decreased intake, increased losses, and upregulated requirements caused by catabolic processes 3,4 . Previous studies have reported that, in patients receiving CRRT, some micronutrients may be easily lost 2,5,6 .…”

Section: Introductionmentioning

confidence: 99%

“…In critical illness, micronutrient deficiencies are common, potentially because of decreased intake, increased losses, and upregulated requirements caused by catabolic processes. 3,4 Previous studies have reported that, in patients receiving CRRT, some micronutrients may be easily lost. 2,5,6 Deficiency of these essential micronutrients may be associated with impaired biochemical function and, thus, potentially poor clinical outcomes in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Serum micronutrient levels in critically ill patients receiving continuous renal replacement therapy: A prospective, observational study

Gündoğan

Yucesoy

Özer

et al. 2022

J Parenter Enteral Nutr

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Background: Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) may deplete micronutrient levels. Patients are also at risk for micronutrient depletion due to underlying illness(s), poor nutrient intake prior to intensive care unit (ICU) admission and/or increased requirements. We determined vitamin and trace element status before, during and after CRRT in critically ill patients.Methods: This prospective observational study performed in mixed medical and surgical ICU patients. Serial serum vitamin B6 and vitamin C concentrations were measured by HPLC and folic acid by ECLIA. Serum chromium, copper, selenium, and zinc were measured using ICP-MS. Serum ceruloplasmin was measured by the Erel method.Results: Fifty adult ICU patients with AKI were recruited. The median APACHE II score on ICU admission was high at 24.0 (6.0-33.0). The median days on CRRT was 2.0 (2.0-4.0) days. At baseline (within 10-15 minutes of CRRT initiation), serum vitamin C, selenium and zinc were below normal. Serum vitamin B6 levels at 72 hours on CRRT were significantly lower than at 24 hours (p = 0.011). Serum vitamin C values fell significantly at 24 and 72 hours during CRRT (p = 0.030 and p = 0.001), respectively, and remained low 24 and 48 hours after CRRT was stopped (p = 0.021). At baseline and during CRRT, 96% of participants had at least two or more micronutrient levels below the normal range. Conclusion:Serum vitamin C, selenium and zinc concentrations were below the normal range at baseline. CRRT was associated with a significant further decrease in levels of vitamin C, selenium and zinc.

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Serum trace elements levels in patients transferred from the intensive care unit to wards

Cited by 5 publications

References 17 publications

Selenium Levels and Antioxidant Activity in Critically Ill Patients with Systemic Inflammatory Response Syndrome

Selenium Levels and Antioxidant Activity in Critically Ill Patients with Systemic Inflammatory Response Syndrome

An update on essential micronutrients in critical illness

Serum micronutrient levels in critically ill patients receiving continuous renal replacement therapy: A prospective, observational study

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