Association of Initial Low Serum Selenium Level with Infectious Complications and 30-Day Mortality in Multiple Trauma Patients.

Soon Bo Choi,Yun Tae Jung,Jae Gil Lee

doi:10.3390/nu11081844

Abstract

Low serum selenium levels are commonly observed in critically injured multiple trauma patients. This study aimed to identify the association between initial serum selenium levels and in-hospital infectious complications in multiple trauma patients. We retrospectively reviewed multiple trauma patients admitted between January 2015 and November 2017. We selected 135 patients whose serum selenium levels were checked within 48 h of admission. Selenium deficiency was defined as a serum selenium level <70 ng/mL. Survival analyses of selenium deficiency and 30-day mortality were performed. Multivariate logistic regression analysis was performed to identify the association between initial serum selenium level and in-hospital infectious complications. Thirty-day mortality (8.3% vs. 0.0%; p = 0.018) and incidence rates of pneumonia (66.7% vs. 28.3%; p < 0.001) and infectious complications (83.3% vs. 46.5%; p < 0.001) were higher in patients with selenium deficiency than in patients without selenium deficiency. Kaplan–Meier survival cures also showed similar results (log rank test, p = 0.021). Of 135 patients, 76 (56.3%) experienced at least one infectious complication during admission. High injury severity score (ISS, odds ratio (OR) 1.065, 95% confidence interval (CI) 1.024–1.108; p = 0.002) and selenium deficiency (OR 3.995, 95% CI 1.430–11.156; p = 0.008) increased the risk of in-hospital infectious complications in multiple trauma patients. Patients with selenium deficiency showed higher 30-day mortality and higher risks of pneumonia and infectious complications.

Highlights

Traumatic injury is one of the most common causes of death worldwide
The first peak in the trimodal model of trauma mortality includes deaths occurring at the scene of the traumatic event
The proportion of deaths in these two peaks has not changed over time, because these deaths depend mainly on the mechanism and severity of the damage caused by an irreversible fatal injury to a patient even before they obtain any medical assistance

Summary

Introduction

Traumatic injury is one of the most common causes of death worldwide. More than 5 million people die due to traumatic injuries every year [1]. Hemorrhage and brain injury are common causes of death in both the early and late peaks of the trimodal model [4], infection and sepsis following multiorgan failure has become one of the major causes of death in the late phases of trauma [3,4,5,6]. This condition is induced by an initial cascade of inflammation resulting in multiple organ damage, which is aggravated by sepsis, caused by increased susceptibility of the patient [7]. Numerous changes and advancements have occurred in Nutrients 2019, 11, 1844; doi:10.3390/nu11081844 www.mdpi.com/journal/nutrients

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