Selenium replacement in patients with severe systemic inflammatory response syndrome improves clinical outcome

Objective: To determine the effect of selenium replacement on morbidity and mortality in patients with systemic inflammatory response syndrome (SIRS), Design: Controlled, randomized prospective open-label pilot study comparing patients with and without selenium replacement, Setting: Intensive care unit of a university hospital for internal medicine . Patients: Forty-two patients with SIPS caused by infection and a minimal Ac ute Physiology and Chronic Health Evaluation (APACHE) II score of 15 points on the day of admission were included. The selenium replacement group of p atients (Se +; n = 21) received sodium selenite for 9 days (535 mu g [6.77 mu mol] for 3 days, 285 mu g [3.61 mu mol] for 3 days, acid 155 mu g [1.96 mu mol] for 3 days) and thereafter, 35 mu g (0.44 mu mol) per day iv. The c ontrol group (Se-, n = 21) received 35 mu g of sodium selenite throughout t he total treatment period, Interventions: Morbidity and clinical outcome was monitored by scoring usin g the APACHE III score, occurrence of acute renal failure, need and length of mechanical ventilation, and hospital mortality. Blood samples on days 0, 3, 7, and 14 were analyzed for serum selenium concentration and glutathion e peroxidase (GSH-Px) activity. Measurements and Main Results: The median APACHE II score at admission, age , gender, underlying diseases, serum selenium levels, and GSH-Px activities at admission were identical in both groups. In Se+ patients, serum seleniu m levels and GSH-Px activity normalized within 3 days, whereas in controls, both variables remained significantly low (p < .0001), The APACHE III scor e decreased significantly in both groups but was significantly lower in the Se+ group (day 3, p > .05; day 7, p = .018; and day 14, p = .045 Se+ compa red with Se-), Hemodialysis with continuous veno-venous hemodialysis becaus e of acute renal failure was necessary in nine Se- compared with three Sepatients (p = .035), Overall mortality in the Se- group was 52% vs, 33.5% i n the Se+ group (p = .13), Conclusions: Selenium replacement in patients with SIRS seems to improve cl inical outcome and to reduce the incidence of acute renal failure requiring hemodialysis.