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VOLUME 21 , ISSUE 5 ( May, 2017 ) > List of Articles

RESEARCH ARTICLE

The effect of high-dose parenteral sodium selenite in critically ill patients following sepsis: A clinical and mechanistic study

Mohammad Abdollahi, Legese Chelkeba, Arezoo Ahmadi, Atabak Najafi, Mohammad Hosein Ghadimi, Reza Mosaed, Mojtaba Mojtahedzadeh

Keywords : High mobility group box-1 protein, mortality, selenium, sepsis, septic shock, severe sepsis, superoxide dismutase

Citation Information : Abdollahi M, Chelkeba L, Ahmadi A, Najafi A, Ghadimi MH, Mosaed R, Mojtahedzadeh M. The effect of high-dose parenteral sodium selenite in critically ill patients following sepsis: A clinical and mechanistic study. Indian J Crit Care Med 2017; 21 (5):287-293.

DOI: 10.4103/ijccm.IJCCM_343_16

License: CC BY-ND 3.0

Published Online: 00-05-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Severe sepsis and septic shock is characterized by inflammation and oxidative stress. Selenium levels have been reported to be low due to loss or increased requirements during severe sepsis and septic shock. We investigated the effect of high-dose parenteral selenium administration in septic patients. Methods: A prospective, randomized control clinical trial was performed in septic patients. After randomization, patients in selenium group received high-dose parenteral sodium selenite (2 mg intravenous [IV] bolus followed by 1.5 mg IV continuous infusion daily for 14 days) plus standard therapy and the control group received standard therapy. The primary endpoint was mortality at 28 days. Changes in the mean levels of high mobility group box-1 (HMGB-1) protein and superoxide dismutase (SOD), duration of vasopressor therapy, incidence of acute renal failure, and 60 days′ mortality were secondary endpoints. Results: Fifty-four patients were randomized into selenium group (n = 29) and control group (n = 25). There was no significant difference in 28-day mortality. No significant difference between the two groups with respect to the average levels of HMGB-1 protein and SOD at any point in time over the course of 14 days had observed. Conclusion: In early administration within the first 6 h of sepsis diagnosis, our study demonstrated that high-dose parenteral selenium administration had no significant effect either on 28-day mortality or the mean levels of HMGB-1 and SOD (Trial Registration: IRCT201212082887N4 at WHO Clinical Trial Registry, August 29, 2014).


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  1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-10.
  2. Daniels R. Surviving the first hours in sepsis: Getting the basics right (an intensivist′s perspective). J Antimicrob Chemother 2011;66 Suppl 2:ii11-23.
  3. Kaczorowski DJ, Nakao A, Vallabhaneni R, Mollen KP, Sugimoto R, Kohmoto J, et al. Mechanisms of toll-like receptor 4 (TLR4)-mediated inflammation after cold ischemia/reperfusion in the heart. Transplantation 2009;87:1455-63.
  4. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med 2013;369:840-51.
  5. Bianchi ME. DAMPs, PAMPs and alarmins: All we need to know about danger. J Leukoc Biol 2007;81:1-5.
  6. Sundén-Cullberg J, Norrby-Teglund A, Rouhiainen A, Rauvala H, Herman G, Tracey KJ, et al. Persistent elevation of high mobility group box-1 protein (HMGB1) in patients with severe sepsis and septic shockFNx01. Crit Care Med 2005;33:564-73.
  7. Gibot S, Massin F, Cravoisy A, Barraud D, Nace L, Levy B, et al. High-mobility group box 1 protein plasma concentrations during septic shock. Intensive Care Med 2007;33:1347-53.
  8. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39:165-228.
  9. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
  10. ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med 2014;370:1683-93.
  11. ARISE Investigators; ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med 2014;371:1496-506.
  12. Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 2015;372:1301-11.
  13. Hotchkiss RS, Opal S. Immunotherapy for sepsis - A new approach against an ancient foe. N Engl J Med 2010;363:87-9.
  14. Wang Z, Forceville X, Van Antwerpen P, Piagnerelli M, Ahishakiye D, Macours P, et al. A large-bolus injection, but not continuous infusion of sodium selenite improves outcome in peritonitis. Shock 2009;32:140-6.
  15. Driscoll DM, Copeland PR. Mechanism and regulation of selenoprotein synthesis. Annu Rev Nutr 2003;23:17-40.
  16. Alonso de Vega JM, Díaz J, Serrano E, Carbonell LF. Oxidative stress in critically ill patients with systemic inflammatory response syndrome. Crit Care Med 2002;30:1782-6.
  17. Motoyama T, Okamoto K, Kukita I, Hamaguchi M, Kinoshita Y, Ogawa H. Possible role of increased oxidant stress in multiple organ failure after systemic inflammatory response syndrome. Crit Care Med 2003;31:1048-52.
  18. Sakr Y, Reinhart K, Bloos F, Marx G, Russwurm S, Bauer M, et al. Time course and relationship between plasma selenium concentrations, systemic inflammatory response, sepsis, and multiorgan failure. Br J Anaesth 2007;98:775-84.
  19. Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, et al. Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet 2002;360:219-23.
  20. Avenell A, Noble DW, Barr J, Engelhardt T. Selenium supplementation for critically ill adults. Cochrane Libr 2004. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15495061. [Last accessed on 2016 Dec 23].
  21. Heyland DK, Dhaliwal R, Suchner U, Berger MM. Antioxidant nutrients: A systematic review of trace elements and vitamins in the critically ill patient. Intensive Care Med 2005;31:327-37.
  22. Manzanares W, Dhaliwal R, Jiang X, Murch L, Heyland DK. Antioxidant micronutrients in the critically ill: A systematic review and meta-analysis. Crit Care 2012;16:R66.
  23. Manzanares W, Biestro A, Torre MH, Galusso F, Facchin G, Hardy G. High-dose selenium reduces ventilator-associated pneumonia and illness severity in critically ill patients with systemic inflammation. Intensive Care Med 2011;37:1120-7.
  24. Berger MM, Reymond MJ, Shenkin A, Rey F, Wardle C, Cayeux C, et al. Influence of selenium supplements on the post-traumatic alterations of the thyroid axis: A placebo-controlled trial. Intensive Care Med 2001;27:91-100.
  25. Berger MM, Spertini F, Shenkin A, Wardle C, Wiesner L, Schindler C, et al. Trace element supplementation modulates pulmonary infection rates after major burns: A double-blind, placebo-controlled trial. Am J Clin Nutr 1998;68:365-71.
  26. Berger MM, Soguel L, Shenkin A, Revelly JP, Pinget C, Baines M, et al. Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients. Crit Care 2008;12:R101.
  27. Andrews PJ, Avenell A, Noble DW, Campbell MK, Croal BL, Simpson WG, et al. Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients. BMJ 2011;342:d1542.
  28. Forceville X, Laviolle B, Annane D, Vitoux D, Bleichner G, Korach JM, et al. Effects of high doses of selenium, as sodium selenite, in septic shock: A placebo-controlled, randomized, double-blind, phase II study. Crit Care 2007;11:R73.
  29. Lindner D, Lindner J, Baumann G, Dawczynski H, Bauch K. Investigation of antioxidant therapy with sodium selenite in acute pancreatitis. A prospective randomized blind trial. Med Klin (Munich) 2004;99:708-12.
  30. Kuklinski B, Zimmermann T, Schweder R. Decreasing mortality in acute pancreatitis with sodium selenite. Clinical results of 4 years antioxidant therapy. Med Klin (Munich) 1995;90 Suppl 1:36-41.
  31. Angstwurm MW, Schottdorf J, Schopohl J, Gaertner R. Selenium replacement in patients with severe systemic inflammatory response syndrome improves clinical outcome. Crit Care Med 1999;27:1807-13.
  32. Mishra V, Baines M, Perry SE, McLaughlin PJ, Carson J, Wenstone R, et al. Effect of selenium supplementation on biochemical markers and outcome in critically ill patients. Clin Nutr 2007;26:41-50.
  33. Angstwurm MW, Engelmann L, Zimmermann T, Lehmann C, Spes CH, Abel P, et al. Selenium in Intensive Care (SIC): Results of a prospective randomized, placebo-controlled, multiple-center study in patients with severe systemic inflammatory response syndrome, sepsis, and septic shockFNx01. Crit Care Med 2007;35:118-26.
  34. Kong Z, Wang F, Ji S, Deng X, Xia Z. Selenium supplementation for sepsis: A meta-analysis of randomized controlled trials. Am J Emerg Med 2013;31:1170-5.
  35. Visser J, Labadarios D, Blaauw R. Micronutrient supplementation for critically ill adults: A systematic review and meta-analysis. Nutrition 2011;27:745-58.
  36. Miller N, Miller M, Hill LT. The impact of antioxidant supplementation on clinical outcomes in the critically ill: A meta-analysis. South Afr J Crit Care 2013;29:18-26.
  37. Huang TS, Shyu YC, Chen HY, Lin LM, Lo CY, Yuan SS, et al. Effect of parenteral selenium supplementation in critically ill patients: A systematic review and meta-analysis. PLoS One 2013;8:e54431.
  38. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644-55.
  39. Chelkeba L, Ahmadi A, Abdollahi M, Najafi A, Ghadimi MH, Mosaed R, et al. The effect of parenteral selenium on outcomes of mechanically ventilated patients following sepsis: A prospective randomized clinical trial. Ann Intensive Care 2015;5:29.
  40. Bloos F, Trips E, Nierhaus A, Briegel J, Heyland DK, Jaschinski U, et al. Effect of sodium selenite administration and procalcitonin-guided therapy on mortality in patients with severe sepsis or septic shock: A randomized clinical trial. JAMA Intern Med 2016;176:1266-76.
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