Effects of high doses of selenium, as sodium selenite, in septic shock: a placebo-controlled, randomized, double-blind, phase II study.
BACKGROUND
Sepsis is associated with the generation of oxygen free radicals and (lacking) decreased selenium plasma concentrations. High doses of sodium selenite might reduce inflammation by a direct pro-oxidative effect and may increase antioxidant cell capacities by selenium incorporation into selenoenzymes. We investigated the effects of a continuous administration of high doses of selenium in septic shock patients.


METHODS
A prospective, multicentre, placebo-controlled, randomized, double-blind study was performed with an intention-to-treat analysis in severe septic shock patients with documented infection. Patients received, for 10 days, selenium as sodium selenite (4,000 microg on the first day, 1,000 microg/day on the nine following days) or matching placebo using continuous intravenous infusion. The primary endpoint was the time to vasopressor therapy withdrawal. The duration of mechanical ventilation, the mortality rates in the intensive care unit, at hospital discharge, and at 7, 14, 28 and 180 days and 1 year after randomization, and adverse events were recorded.


RESULTS
Sixty patients were included (placebo, n = 29; selenium, n = 31). The median time to vasopressor therapy withdrawal was 7 days in both groups (95% confidence interval = 5-8 and 6-9 in the placebo and selenium groups, respectively; log-rank, P = 0.713). The median duration of mechanical ventilation was 14 days and 19 days in the placebo and selenium groups, respectively (P = 0.762). Mortality rates did not significantly differ between groups at any time point. Rates of adverse events were similar in the two groups.


CONCLUSIONS
Continuous infusion of selenium as sodium selenite (4,000 microg on the first day, 1,000 microg/day on the nine following days) had no obvious toxicity but did not improve the clinical outcome in septic shock patients. Trial Registration = NCT00207844.
Forceville
Xavier
X
Service de Réanimation Polyvalente, Centre Hospitalier de Meaux, Hôpital Saint Faron, 6-8 rue Saint Fiacre, 77104 Meaux, France. xforceville@invivo.edu
Laviolle
Bruno
B
Annane
Djillali
D
Vitoux
Dominique
D
Bleichner
Gérard
G
Korach
Jean-Michel
JM
Cantais
Emmanuel
E
Georges
Hugues
H
Soubirou
Jean-Louis
JL
Combes
Alain
A
Bellissant
Eric
E
D000368:Aged; D000975:Antioxidants / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy*; D018038:Sodium Selenite / Q000627:therapeutic use*; D016896:Treatment Outcome
D000975:Antioxidants; D018038:Sodium Selenite