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

Introduction

High doses of selenium (Se) may improve the condition of ICU patients with respect to its involvement in antioxidative protection and other tasks. In the previous work we concluded, that the decrease of 28-day mortality is not significant. Now procalcitonin (PCT), C-reactive protein (CRP) and Sequential Organ Failure Assessment (SOFA), as markers of the severity of actual status, were monitored and evaluated in relation to the plasma Se concentration.

Methods

One hundred and forty patients were randomized into groups A and B. Group A received standard Se substitution: 30 to 75 μg/day NaSelenite intravenously; group B received Se substitution according to a protocol: 1,000 μg at day 1, followed with 500 μg at days 2 to 14. These groups were divided into four subgroups: systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock. Plasma levels of Se, CRP and PCT were examined. SOFA and 28-day mortality were evaluated as clinical markers. Relations between parameters were evaluated statistically. In both groups, transitions among subgroups during treatment were evaluated. All patients monitored less than three times were excluded.

Results

Negative correlations between Se × PCT, Se × SOFA and Se × CRP were found (Table 1). Correlation coefficients (r) were statistically significantly higher in group B. Evaluation of transitions among subgroups during treatment showed there was a difference in subgroup septic shock between groups A and B. Into the less severe stage of sepsis moved 28% in group A (14 examinations) and 44% (16 examinations) in group B.

Table 1 Negative correlations

Conclusion

There were more significant negative correlations between plasmatic Se and parameters of inflammation in the group of patients supplemented with high doses of Se. In accordance was a finding of more frequent transition from septic shock to a less severe stage of sepsis. Even if a decrease of mortality was again not found, the presented results may perhaps indicate a positive metabolic influence in critical illness.