The role of selenium in critical illness: Basic science and clinical implications

Abstract

Over the last century, our understanding of selenium has progressed considerably and we have come to recognize it as an essential component or cofactor of enzymes throughout metabolism, such as glutathione peroxidase (GPx), thioredoxine reductase and iodine deiodinase. GPx acts against hydrogen peroxide and lipid peroxidation and is an important line of defense against free radicals; thioredoxine reductase is involved in nucleus redox status; and iodine deiodinase is involved in thyroid hormone metabolism, which is frequently impaired in critically ill patients. Selenium also has an anticarcinogenic effect that is thought to be induced by the production of methyselenol, a selenometabolite that affects gene expression and modifi es cell cycling and immune function. We review current knowledge concerning clinically relevant selenoproteins, discuss the potential role of these compounds in health and disease, review the epidemiology of selenium defi ciency and its clinical implications with a special emphasis on critically ill patients and discuss the role of selenium supplementation in critical care settings.

Zinc and selenium status in critically ill patients according to severity stratification

“…The importance of the role of micronutrients in critically ill patients is well documented [1,2]. Low zinc concentrations have been reported in patients admitted to the intensive care unit (ICU) [3], and plasma selenium levels are commonly decreased in critically ill patients for various reasons [4,5].…”

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

“…It is of great importance in human health and plays a key role in thyroid function, antioxidant defence and immune function. Plasma Se levels are commonly decreased in critically ill patients for several reasons, including decreased Se intake, haemodilution by resuscitation fluids and incompletely replaced loss of biological fluids that contain large quantities of trace elements (mainly blood loss) [ 1 , 2 ]. In addition, Se requirements may increase while a patient has inflammatory conditions, owing to the increase in oxidative stress and production of reactive oxygen species (ROS) [ 2 , 3 ].…”

The Effect of Sodium Selenite on the Acute Phase Protein Response and Plasma Variables in Patients Admitted in ICU

“…The effect of the acute phase response for detection infection in patients with sepsis is still controversial and a number of studies of the effectiveness use of procalcitonin level or other acute phase response (such as CRP), in order to tailor the differentiation differentiate sepsis from other causes of acute inflammatory, generalized inflammation was not proved. Therefore, there was no advice on the use of these markers for application in differentiating between serious infections and other acute inflammatory conditions (3,(20)(21)(22).…”

“…That while the conduct of clinical trials on the efficacy of different doses of selenium, as well as ambiguities and questions to determine the best dose and the administration of what they do. Although the clinical treatment of patients with septic shock is a dynamic and evolving process (20), new clinical methods with different approaches to the treatment of sepsis and septic shock, as well as international guidelines on the treatment and survival of these patients have played a significant role. However, there is a need to conduct further multicenter clinical trials in this field and integration and combining the clinical knowledge and experience to generalize the results of evidencebased clinical studies.…”