title: Increased plasma selenium is associated with better outcomes in children with systemic inflammation.
abstract: OBJECTIVE
  The aim of this study was to assess the effects of changes in plasma selenium on the outcome of critically ill children.
  
  
  METHODS
  Plasma selenium was prospectively measured in 99 children with acute systemic inflammation. The exposure variables were selenium level on admission and on day 5 of stay in the intensive care unit (ICU) and the difference in selenium concentrations between day 5 post-admission and the ICU admission (delta selenium). Selenium was given only as part of enteral diets. Age, malnutrition, red cell glutathione peroxidase-1 activity, serum C-reactive protein, Pediatric Index of Mortality 2, and Pediatric Logistic Organ Dysfunction scores were analyzed as covariates. The outcome variables were ventilator-free days, ICU-free days, and 28-d mortality.
  
  
  RESULTS
  Plasma selenium concentrations increased from admission (median 23.4 μg/L, interquartile range 12.0-30.8) to day 5 (median 25.1 μg/L, interquartile range 16.0-39.0; P = 0.018). After adjustment for confounding factors, a delta selenium increase of 10 μg/L was associated with reductions in ventilator days (1.3 d; 95% confidence interval [CI], 0.2-2.3; P = 0.017) and ICU days (1.4 d; 95% CI, 0.5-2.3; P < 0.01). Delta selenium >0 was associated with decreased 28-d mortality on a univariate model (odds ratio, 0.67; 95% CI, 0.46-0.97; P = 0.036). The mean daily selenium intake (6.82 μg; range 0-48.66 μg) was correlated with the increase in selenium concentrations on day 5.
  
  
  CONCLUSIONS
  An increase in plasma selenium is independently associated with shorter times of ventilation and ICU stay in children with systemic inflammation. These findings raise the hypothesis that selenium supplementation could be beneficial in children with critical illnesses.
authors.affiliation: Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil. Electronic address: heitorpons@gmail.com.
authors.forename: Heitor Pons
authors.initials: HP
authors.lastname: Leite
authors.affiliation: Pediatric Nephrology Section, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Paulo Cesar Koch
authors.initials: PC
authors.lastname: Nogueira
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Simone Brasil de Oliveira
authors.initials: SB
authors.lastname: Iglesias
authors.affiliation: Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Susyane Vieira
authors.initials: SV
authors.lastname: de Oliveira
authors.affiliation: Discipline of Allergy and Immunology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Roseli Oselka Saccardo
authors.initials: RO
authors.lastname: Sarni
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial; D012643:Selenium / Q000097:blood* / Q000494:pharmacology / Q000627:therapeutic use; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein; D012643:Selenium
keywords: Artificial; Intensive care units; Length of stay; Micronutrients; Prognosis; Respiration; Selenium