Antioxidant nutrients: a systematic review of trace elements and vitamins in the critically ill patient (original) (raw)
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Effect of selenium supplementation on biochemical markers and outcome in critically ill patients
Clinical Nutrition, 2007
Background & Aims: This study aimed to assess the effect of high dose selenium (Se) supplementation on Se status in blood, oxidative stress, thyroid function and possible effects on requirement for renal replacement therapy (RRT) in severely septic patients admitted to the intensive care unit (ICU). Methods: This prospective single-centre study was carried out in 40 septic ICU patients who were randomized to high dose Se (Se+ group, N ¼ 18 (474, 316,158 mg/day), each for 3 consecutive days followed by a standard dose of 31.6 mg/day of Se given as sodium selenite whereas the control group (SeÀ, N ¼ 22) received only the standard dose of Se. Plasma Se, glutathione peroxidase (GSH-Px), F2 isoprostanes, thyroid function tests (total T4 and total T3), C-reactive protein (CRP) and red blood cell (RBC) GSH-Px were estimated on day 0, 3, 7, 14. Results: In the Se+ group, plasma Se increased by day 3 and 7 (Po0.0001) and day 14 (P ¼ 0.02), plasma GSH-Px increased by day 3 and 7 (P ¼ 0.01) as compared to SeÀ group. There was a significant negative correlation between plasma Se and SOFA (sepsis related organ failure assessment) (r ¼ À0.36, P ¼ 0.03) along with low plasma Se and high CRP at the time of admission. Requirement for renal replacement therapy was not significantly different between the groups. Conclusion: Although high dose Se supplementation increased plasma Se and GSH-Px activity, it did not reduce oxidative damage or the requirement for RRT. Se levels in blood ARTICLE IN PRESS .uk (V. Mishra).
Selenium: an important trace element and therapeutic adjunct in critical care
Trace Elements and Electrolytes, 2012
Selenium (Se) is an important micronutrient affecting multiple physiologic functions. Low Se levels observed in a general population are mainly caused by its limited availability in the diet. Se, incorporated in seleno-enzymes, plays a key role in protection against oxidative stress, a principle phenomenon in inflammatory response and sepsis. Se levels decrease early in inflammation. This decrease is probably caused by destruction of the enzymes as well as redistribution of Se, and its consumption. Se and seleno-enzyme levels correlate well with biomarkers and severity of sepsis. This observation sparked a hypothesis that Se supplementation would restore Se levels, improving the morbidity and mortality in sepsis. Standard-dose supplementation did not normalize Se levels. In contrast, high-dose supplementation in systemic inflammation and sepsis restored Se levels and improved some biomarkers of sepsis in several smallscale early studies. Similar benefits were observed in both experimental and clinical studies in cerebral insults. However, despite a well-established pathophysiologieal role of Se in reducing oxidative stress in systemic inflammation, recent large clinical studies did not ftiUy confirm a substantial benefit of high-dose Se supplementation in sepsis. Well-designed prospective studies are needed to establish the role of Se in therapy of critically ill patients.
Selenium supplementation in critically ill patients: A systematic review and meta-analysis
Journal of Critical Care, 2014
The oxidative stress is recognized as a constant feature in critical illness. Nevertheless, the use of antioxidant therapy remains controversial. We tried to demonstrate that intravenous selenium supplementation could promote antioxidant status and help protect against infection and organ failure, improving outcome in critically ill patients. Materials and Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the exogenous supplementation of selenium versus standard therapy without any adjuvant in critically ill adults. Results: Nine RCTs met inclusion criteria. Selenium supplementation was associated with a reduction in 28day mortality of borderline statistical significance (risk ratio = 0.84, 95% confidence interval 0.71-0.99, P = .04). The analysis of pre-defined subgroups detected no significant effects regarding the supplementation with doses of selenium ≤ 500 μg/d, administration of a load dose with a bolus and duration of treatment. Only 2 studies analyzed 6-month mortality and could not show a difference. No effects could be demonstrated on hospital length of stay, pulmonary infections, or renal failure. Conclusions: The use of high-dose selenium might be associated with a beneficial effect on 28-day mortality in critically ill patients. Nevertheless, the use of selenium as adjuvant therapy needs further evaluations.
Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis
Critical Care, 2012
Introduction: Critical illness is characterized by oxidative stress, which is a major promoter of systemic inflammation and organ failure due to excessive free radical production, depletion of antioxidant defenses, or both. We hypothesized that exogenous supplementation of trace elements and vitamins could restore antioxidant status, improving clinical outcomes.
Metabolites
The Selenium (Se) status could be an important modifiable factor in critically ill patient outcomes due to the important role of this mineral in several functions. Although there are many clinical trials with Se interventions in the literature, the evidence is not sufficient to establish a common criterion regarding the Se status. Background and aims: An analysis was made of the evolution of selenium (Se) and antioxidant status in critically ill patients with Systemic Inflammatory Response Syndrome (SIRS) over 7 days of staying in the Intensive Care Unit (ICU). Methods: A prospective analytical study was carried out on 65 critically ill patients aged 31–77 years. A healthy control group of 56 volunteers from the same region was recruited to allow comparisons with reference normal values. The selenium levels in both the plasma and erythrocytes were analyzed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Glutathione Peroxidase (GPx) and Superoxide Dismutase (SOD) activity a...
The effects of selenium supplementation on inflammatory markers in critically ill patients
SN Applied Sciences
Low serum selenium (Se) levels have been shown in critical illness, which is associated with poor clinical outcomes and a higher mortality rate. Se plays an important role in inflammation and oxidative stress. Since the overproduction of inflammatory cytokines and increased oxidative stress is a major component of critical illnesses, its supplementation has been demonstrated to have promising effects on critically ill patients. This study aims to review the evidence regarding the effects of Se supplementation on inflammatory and oxidative markers in critically ill patients. The literature review highlights alterations of inflammatory markers, including procalcitonin, leukocyte count, albumin, prealbumin, C-reactive protein (CRP), inflammatory cytokines, and cholesterol following Se supplementation in critically ill patients. Besides, the antioxidant properties of Se due to its presence in the structure of several selenoenzymes have been reported. Article highlights Low serum Se leve...
2020
Background: Pediatric observational studies have indicated that most critically ill children have low serum selenium level, which is associated with the increased incidence of multiple organ failure and deteriorated clinical outcomes. Selenium plays a key role in the endogenous antioxidant defense mechanism and inflammatory pathways. Objectives: The present study aimed to assess the effects of high-dose selenium supplementation on the improvement of inflammatory and oxidative stress indices, as well as clinical outcomes, in pediatric patients with severe oxidative stress and inflammation following major gastrointestinal surgeries. Methods: This prospective, single-blind, randomized, parallel group superiority trial was conducted at the pediatric intensive care unit (PICU) of Akbar Pediatric Hospital in Mashhad, Iran in 2019. Patients were assigned to the supplementation (high-dose selenium: 20 µg/kg/d) and control groups (placebo with the recommended dietary allowance doses of selen...