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Effect of high-dose selenium substitution on selected laboratory parameters and prognosis in critically ill patients

Introduction

Standard selenium (Se) substitution (30–75 μg/day; 0.4–0.9 μmol/l) in the critically ill is not sufficient for a sustained plasma level (0.58–1.82 μmol/l; 46–143 μg/l). Standard Se substitution keeps the plasma level in the range 0.28–0.42 μmol/l. High-dose Se substitution correlated with a decrease in mortality of patients with SIRS. The influence of high-dose substitution on selected parameters, MAP and mortality in the critically ill were evaluated in a prospective randomized clinical trial.

Methods

One hundred and twenty-three patients (78 males, 45 females, median age 62.7 and 60 years, respectively) were randomized into group A (SOFA 19.27) and group B (SOFA 10.23). Group A received standard Se substitution: 30–75 μg NaSelenite i.v./day. Group B received high-dose Se substitution according to a protocol: 1,000 μg at day 1, followed with 500 μg at days 2–14 of NaSelenite i.v. The plasma levels of Se, prealbumin, albumin, CRP, PCT, cholesterol, gluthathionperoxidase GSHPx, D-dimer, creatinine clearance and leucocytes were examined daily. MAP trends and 28-day mortality were evaluated as clinical markers.

Results

The Se plasma level was significantly higher in high-dose Se-substituted patients (0.56 μmol/l vs 0.88 μmol/l, P < 0.001). GSHPx was significantly higher in high-dose Se-substituted patients (4,864 U/l vs 6,097 U/l, P < 0.001). No significant differences were found in the level of albumin, prealbumin, CRP, PCT, leucocytes, fibrinogen, cholesterol, D-dimer and creatinine clearance and MAP. The 28-day mortality was lower in a high-dose Se-substituted patients (33% vs 37%), but not significantly.

Conclusion

The critically ill have an increased demand for Se, which is essential for synthesis of Se enzymes and Se proteins. The increased demand for Se is not covered by standard substitution. High-dose Se substitution (500–1,000 μg/day) normalizes its plasma level and increases the GSHPx plasma level. High-dose Se substitution has no adverse reactions. The decrease of 28-day mortality in high-dose Se-substituted patients is not significant. The trial on high-dose Se substitution further continues.

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Valenta, J., Brodska, H., Kazda, A. et al. Effect of high-dose selenium substitution on selected laboratory parameters and prognosis in critically ill patients. Crit Care 11, P155 (2007). https://doi.org/10.1186/cc5315

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Keywords

  • Cholesterol
  • Selenium
  • Plasma Level
  • Fibrinogen
  • Creatinine Clearance