Restoration of antioxidant enzymes in the therapeutic use of selenium in septic patients.

Abstract

A prospective observational study of parenteral selenium supplementation started in January 2008 which included 72 septic patients with APACHE II scores ranging from 19 to 40 after admission.Patients were divided into two major groups: one with a continual infusion of sodium selenite at 750 µg/24 h for 6 days and a placebo group followed by subgroups according to the presence or absence of surgical procedure. Routine biochemical and hematological para-meters were determined continuously. Sequential Organ Failure Assessment (SOFA) scores were calculated in two-day intervals.Patients who died had a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, lower albumin on the 3rd days of therapy and higher C-reactive protein (CRP) on the 6th days of therapy. Statistically, there was no significant difference in the comparison of CRP, fibrinogen, albumin, plasma proteins, or neutrophil to lymphocyte counts during the 6 days in all subgroups. There was a significant difference in the comparison of leukocytes on the 6th day of therapy. Glutathione peroxidase and glutathione reductase activity was increased in selenium subgroups with negative correlation in placebo subgroups during the therapy. A downward trend in SOD activity, more appreciable in selenium groups, seemed to be a reflection of lower superoxide radical production. This is biased more as a result of GPx activity restoration, preventing further peroxidation of organic substrates and cyclic formation of other radicals, than actual attenuation of their production.Selenium substitution increased selenium dependent antioxidant enzyme activity and, in comparing mortality in groups, we found a 16.7 % decrease in mortality in favor of supplementation with selenium.