title: The intraoperative decrease of selenium is associated with the postoperative development of multiorgan dysfunction in cardiac surgical patients.
abstract: OBJECTIVE
  The trace elements selenium, copper, and zinc are essential for maintaining the oxidative balance. A depletion of antioxidative trace elements has been observed in critically ill patients and is associated with the development of multiorgan dysfunction and an increased mortality. Cardiac surgery using cardiopulmonary bypass provokes ischemia-reperfusion-mediated oxidative stress. We hypothesized that an intraoperative decrease of circulating trace elements may be involved in this response.
  
  
  METHODS
  Prospective observational clinical study.
  
  
  METHODS
  University hospital cardiothoracic operation theater and intensive care unit.
  
  
  METHODS
  Sixty patients (age 65 ± 14 yrs) undergoing cardiac surgery with the use of cardiopulmonary bypass.
  
  
  RESULTS
  Whole blood concentrations of selenium, copper, and zinc were measured after induction of anesthesia and 1 hr after admission to the intensive care unit. All patients were separated in a priori defined subgroups according to the development of no organ failure, single organ failure, and ≥ 2 organ failures in the postoperative period.
  
  
  RESULTS
  Fifty patients exhibited a significant selenium deficiency already before surgery, whereas copper and zinc concentrations were within the reference range. In all patients, blood levels of selenium, copper, and zinc were significantly reduced after end of surgery when compared to preoperative values (selenium: 89.05 ± 12.65 to 70.84 ± 10.46 μg/L; zinc: 5.15 ± 0.68 to 4.19 ± 0.73 mg/L; copper: 0.86 ± 0.15 to 0.65 ± 0.14 mg/L; p < .001). During their intensive care unit stay, 17 patients were free from any organ failure, while 31 patients developed single-organ failure and 12 patients multiple organ failure. Multilogistic regression analysis showed that selenium concentrations at end of surgery were independently associated with the postoperative occurrence of multiorgan failure (p = .0026, odds ratio 0.8479, 95% confidence interval 0.7617 to 0.9440).
  
  
  CONCLUSIONS
  Cardiac surgery using cardiopulmonary bypass resulted in a profound intraoperative decrease of whole blood levels of antioxidant trace elements. Low selenium concentrations at end of surgery were an independent predictor for the postoperative development of multiorgan failure.
authors: Department of Anaesthesiology, University Hospital, RWTH Aachen, Germany.
authors: Christian
authors: C
authors: Stoppe
authors: Gereon
authors: G
authors: Schälte
authors: Rolf
authors: R
authors: Rossaint
authors: Mark
authors: M
authors: Coburn
authors: Beatrix
authors: B
authors: Graf
authors: Jan
authors: J
authors: Spillner
authors: Gernot
authors: G
authors: Marx
authors: Steffen
authors: S
authors: Rex
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001774:Blood Chemical Analysis; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000379:methods / Q000401:mortality; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003300:Copper / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009102:Multiple Organ Failure / Q000097:blood* / Q000401:mortality; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011446:Prospective Studies; D012643:Selenium / Q000097:blood*; D015996:Survival Rate; D014131:Trace Elements / Q000097:blood*; D015032:Zinc / Q000097:blood
chemical_list: D015415:Biomarkers; D014131:Trace Elements; D003300:Copper; D012643:Selenium; D015032:Zinc