title: Biomarkers in critically ill patients with systemic inflammatory response syndrome or sepsis supplemented with high-dose selenium.
abstract: OBJECTIVE
  Low levels of selenium (Se) and glutathione peroxidase (GSHPx), a key selenoenzyme, were documented in systemic inflammatory response syndrome (SIRS) and sepsis, both associated with high mortality. Se supplementation had mixed effects on outcome. We hypothesized that Se supplementation could have a different impact on biomarkers and 28-day mortality in patients with SIRS vs. sepsis.
  
  
  METHODS
  Adult patients with SIRS or sepsis were randomized to either high-dose (Se+, n = 75) or standard-dose (Se-, n = 75) Se supplementation. Plasma Se, whole blood GSHPx activity, C-reactive protein (CRP), procalcitonin (PCT), prealbumin, albumin and cholesterol levels were measured serially up to day 14.
  
  
  RESULTS
  There was no difference in mortality between Se- (24/75) vs. Se+ group (19/75; p = 0.367) or between SIRS and septic patients (8/26 vs. 35/124; p = 0.794). There was a trend to reduced mortality in SIRS patients in the Se+ vs. Se- group (p = 0.084). Plasma Se levels increased in the Se+ group only in patients with sepsis but not in patients with SIRS. Plasma Se levels correlated with GSHPx. In SIRS/Se+ group, Se correlated only with GSHPx. In SIRS/Se- group, Se correlated with cholesterol but not with other biomarkers. In sepsis patients, Se levels correlated with cholesterol, GSHPx and prealbumin. Cholesterol levels were higher in survivors in the Se- group.
  
  
  CONCLUSIONS
  Se levels correlated with GSHPx activity and other nutritional biomarkers with significant differences between SIRS and sepsis groups. High-dose Se supplementation did not affect mortality but a strong trend to decreased mortality in SIRS patients warrants further studies in this population.
authors.affiliation: Institute of Clinical Biochemistry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: Helena
authors.initials: H
authors.lastname: Brodska
authors.affiliation: Department of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Valenta
authors.affiliation: Institute of Clinical Biochemistry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: Karin
authors.initials: K
authors.lastname: Malickova
authors.affiliation: Department of Internal Medicine, Nutrition and Dietetic Center, Thomayer University Hospital, Prague, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Kohout
authors.affiliation: Institute of Clinical Biochemistry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: Antonin
authors.initials: A
authors.lastname: Kazda
authors.affiliation: Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. Electronic address: drabekt@anes.upmc.edu.
authors.forename: Tomas
authors.initials: T
authors.lastname: Drabek
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D016638:Critical Illness; D019587:Dietary Supplements; D005260:Female; D005979:Glutathione Peroxidase / Q000097:blood; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D012643:Selenium / Q000097:blood / Q000494:pharmacology*; D018805:Sepsis / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005979:Glutathione Peroxidase; D012643:Selenium
keywords: Albumin; Cholesterol; Glutathione peroxidase; Mortality; Outcome; Prealbumin; Selenium; Selenoenzymes; Sepsis; Systemic inflammatory response syndrome