Selenium substitution in patients with severe systemic inflammatory response syndrome (SIRS)

Objective

To determine the effect of selenium substitution on morbidity and mortality in patients with systemic inflammatory response syndrom (SIRS).

Design

Controlled randomized prospective pilotstudy comparing patients with or without selenium substitution in an intensive care unit of an university hospital for internal medicine. 42 patients were included with SIRS due to infection and a minimal APACHE-II score of 15 points on the day of admission. The selenium substitution group (Se+) received sodiumselenite during 9 days (535 μg for 3 days, 285 μg for 3 days and 155 μg for 3 days) and thereafter 35 μg per day i.v. (Se+, n = 2), the control group (Se-) received 35 μg sodiumselenite throughout treatment period (Se-, n = 21).

Interventions

Morbidity and clinical outcome was monitored by scoring using the APACHE-III score, occurrence of acute renal failure, need and length of mechanical ventilation and hospital mortality. Blood samples on day 0, 3, 7 and 14 were analysed for serum selenium concentration and glutathion peroxidase activity.

Main results

The median APACHE-III score on admission, age, sex, underlying diseases, serum selenium levels and glutathion peroxidase activities on admission were identical in both groups. In Se+ patients serum selenium levels and glutathion peroxidase activity normalised within 3 days, whereas in controls both parameters remained low (P < 0.0001). APACHE-III score improved on days 7 and 14 in the Se+ group (P = 0.018). Hemofiltration of acute renal failure was necessary in 9 Se- compared to 3 Se+ patients (P = 0.035). Overall mortality in Se- group was 55 % versus 33.5 % in the Se+ group.

Conclusion

Selenium substitution in patients with SIRS improves clinical outcome and reduces the incidence of acute renal failure.