Effect of parenteral selenium supplementation in critically ill patients: a systematic review and meta-analysis.

Ting-Shuo Huang,Huang-Yang Chen,Chia-Ying Lo,Pei-Jer Chen,Li-Mei Lin,Yu-Chiau Shyu,Shin-Sheng Yuan,Heiner K Berthold

doi:10.1371/journal.pone.0054431

Abstract

BackgroundIt is currently unclear whether parenteral selenium supplementation should be recommended in the management of critically ill patients. Here we conducted a systematic review and meta-analysis to assess the efficacy of parenteral selenium supplementation on clinical outcomes.Methods/Principal FindingsRandomized trials investigating parenteral selenium supplementation administered in addition to standard of care to critically ill patients were included. CENTRAL, Medline, EMBASE, the Science Citation Index, and CINAHL were searched with complementary manual searches. The primary outcome was all-cause mortality. Trials published in any language were included. Two authors independently extracted data and assessed trial quality. A third author was consulted to resolve disagreements and for quality assurance. Twelve trials were included and meta-analysis was performed on nine trials that recruited critically ill septic patients. These comprised 965 participants in total. Of these, 148 patients (30.7%) in the treatment groups, and 180 patients (37.3%) in control groups died. Parenteral selenium treatment significantly reduced all-cause mortality in critically ill patients with sepsis (relative risk [RR] 0.83, 95% CI 0.70–0.99, p = 0.04, I2 = 0%). Subgroup analyses demonstrated that the administration schedule employing longer duration (RR 0.77, 95% CI 0.63–0.94, p = 0.01, I2 = 0%), loading boluses (RR 0.73, 95% CI 0.58–0.94, p = 0.01, I2 = 0%) or high-dose selenium treatment (RR 0.77, 95% CI 0.61–0.99, p = 0.04, I2 = 0%) might be associated with a lower mortality risk. There was no evidence of adverse events.Conclusions/SignificanceParenteral selenium supplementation reduces risk of mortality among critically ill patients with sepsis. Owing to the varied methodological quality of the studies, future high-quality randomized trials that directly focus on the effect of adequate-duration of parenteral selenium supplementation for severe septic patients are needed to confirm our results. Clinicians should consider these findings when treating this high-risk population.Systematic Review RegistrationPROSPERO 2011; CRD42011001768

Highlights

Sepsis is the leading cause of mortality in critically ill patients and its incidence has increased over the past few decades [1,2,3,4]
An up-to-date systematic review demonstrated that mortality rates among general intensive care unit (ICU) patients with sepsis and septic shock ranges from 21% to 53% [1]
Almost all patients with sepsis admitted to ICUs have low plasma selenium levels and GPx3 activity, which correlates inversely with severity of sepsis and mortality rate [12,13]

Summary

Introduction

Sepsis is the leading cause of mortality in critically ill patients and its incidence has increased over the past few decades [1,2,3,4]. Selenocysteine is inserted into the active centre of functional pivotal selenoproteins and has a range of pleiotropic effects, including antioxidant and immunomodulatory, and increasing anti-viral immunity [10,11]. Among these selenoproteins, the glutathione peroxidase (GPx) selenoenzymes (GPx-1 and GPx-3) and selenoprotein P, play a role in protecting cells from free radical-induced oxidative stress [10]. Low plasma selenium levels are associated with an increasing risk of nosocomial infections [12] It is currently unclear whether parenteral selenium supplementation should be recommended in the management of critically ill patients. We conducted a systematic review and meta-analysis to assess the efficacy of parenteral selenium supplementation on clinical outcomes

Methods

Results

Discussion

Conclusion