Affiliations: Klinikum der Ludwig-Maximilians-Universität
München, Medizinische Klinik- Innenstadt, Germany
Abstract: Patients with systemic inflammatory response syndrome (SIRS) and
sepsis exhibit decreased plasma selenium and glutathione peroxidase activity.
This has been shown in several clinical studies. Moreover, the degree of
selenium deficiency correlates with the severity of the disease and the
incidence of mortality. Patients with SIRS and sepsis are exposed to severe
oxidative stress. Selenoenzymes play a major role in protecting cells against
peroxidation, especially lipid peroxidation and are involved in the regulation
of inflammatory processes. Therefore, selenium substitution in those patients
might be effective in the prevention of multiorgan failure. The results of randomised clinical trials investigating selenium
substitution in critical ill patients with inflammation are reviewed. In two
independently performed randomised, prospective clinical trials, including
patients with systemic inflammatory response syndrome or sepsis, the
supplementation of selenium revealed a significant reduction in multiorgan
failure and, especially, a lower incidence of acute renal failure and
respiratory distress syndrome. One of those trials also could demonstrate a
significant reduction of mortality in the most severely ill patients. Two other
studies, where selenium together with other trace elements or a mixture of
antioxidants were used in the treatment of patients with severe burn injuries
or trauma showed a significant reduction in the secondary infection rate,
including sepsis. Thus, selenium supplementation seems to improve the outcome
of patients with SIRS, sepsis and severe injury, however, pivotal prospective
clinical trials with sufficient statistical power are now necessary to finally
prove the efficacy of a selenium supplementation in these diseases.
