Yasser Sakr, Vivian PL Maia, Clesar Santos, Julia Stracke, Mohamed Zeidan, Ole Bayer, Konrad Reinhart Critical Care 2014, 18:R68 (9 April 2014)

Introduction: Plasma selenium (Se) concentrations are reduced in critically ill surgical patients and lower plasma Se concentrations are associated with worse outcomes. We investigated whether adjuvant Se supplementation in the form of sodium selenite could improve outcomes in surgical patients with sepsis.

Methods: In this retrospective study, all adult patients admitted to a 50-bed surgical ICU with severe sepsis between January 2004 and April 2010 were included and analyzed according to whether or not they had received adjuvant Se supplementation, which was given at the discretion of the attending physician. When prescribed, Se was administered in the form of sodium selenite pentahydrate (Na2SeO3.5H2O), in which 100 mug of Se corresponds to 333 mug of sodium selenite. A bolus of sodium selenite corresponding to 1000 mug of Se was injected intravenously through a central venous line over 30 minutes followed by infusion of 1000 mug/day over 24 hours for 14 days until ICU discharge or death. We performed a logistic regression analysis to investigate the impact of adjuvant Se supplementation on hospital mortality.

Results: Adjuvant Se was administered to 413 (39.7%) of the 1047 patients admitted with severe sepsis. Age and sex were similar in patients who received adjuvant Se and those who did not, but patients who received adjuvant Se supplementation had greater simplified acute physiology score (SAPS) II, a higher prevalence of cancer on admission to the ICU, and were more commonly admitted after abdominal surgery than patients who did not. Patients who received adjuvant Se had higher hospital mortality rates (46 versus 39.1%, P = 0.027) and longer ICU (15 (6 to 24) versus 11 (4 to 24), P = 0.01) and hospital (33 (21 to 52) versus 28 (17 to 46), P = 0.001) lengths of stay than those who did not. In multivariable analysis, adjuvant Se supplementation was not independently associated with favourable outcome (odds ratio = 1.19, 95% confidence interval: 0.86 to 1.65, P = 0.288).

Conclusions: In this retrospective analysis of a large cohort of surgical ICU patients with severe sepsis, adjuvant Se supplementation in the form of sodium selenite had no impact on in-hospital death after adjustment for confounders.

weblink here