Wiener klinische Wochenschrift

, Volume 125, Issue 11–12, pp 316–325 | Cite as

Restoration of antioxidant enzymes in the therapeutic use of selenium in septic patients


  • Vašková Janka
  • Kočan Ladislav
  • Firment Jozef
  • Vaško Ladislav
original article

Summary

A prospective observational study of parenteral selenium supplementation started in January 2008 which included 72 septic patients with APACHE II scores ranging from 19 to 40 after admission.

Patients were divided into two major groups: one with a continual infusion of sodium selenite at 750 µg/24 h for 6 days and a placebo group followed by subgroups according to the presence or absence of surgical procedure. Routine biochemical and hematological para-meters were determined continuously. Sequential Organ Failure Assessment (SOFA) scores were calculated in two-day intervals.

Patients who died had a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, lower albumin on the 3rd days of therapy and higher C-reactive protein (CRP) on the 6th days of therapy. Statistically, there was no significant difference in the comparison of CRP, fibrinogen, albumin, plasma proteins, or neutrophil to lymphocyte counts during the 6 days in all subgroups. There was a significant difference in the comparison of leukocytes on the 6th day of therapy. Glutathione peroxidase and glutathione reductase activity was increased in selenium subgroups with negative correlation in placebo subgroups during the therapy. A downward trend in SOD activity, more appreciable in selenium groups, seemed to be a reflection of lower superoxide radical production. This is biased more as a result of GPx activity restoration, preventing further peroxidation of organic substrates and cyclic formation of other radicals, than actual attenuation of their production.

Selenium substitution increased selenium dependent antioxidant enzyme activity and, in comparing mortality in groups, we found a 16.7 % decrease in mortality in favor of supplementation with selenium.

Keywords

Oxidative stress Sepsis Selenium Artificial nutrition 

Wiederherstellung der Aktivität von antioxidativen Enzymen durch Selen bei septischen Patienten

Zusammenfassung

Eine prospektive Beobachtungsstudie der Wirkung einer parenteralen Gabe von Selen wurde im Jänner 2008 begonnen. Es wurden 72 Patienten mit Sepsis und einem APACHE II Score zwischen 19 und 40 bei Aufnahme in die Studie aufgenommen.

Die Patienten wurden in 2 große Gruppen eingeteilt: einer Gruppe wurde eine kontinuierliche Infusion von 750 mg Na-Selenit/24 h 6 Tage lang verabreicht – der anderen Placebo. Es wurden dann Subgruppen gebildet, je nachdem, ob operative Maßnahmen gesetzt wurden. Routine biochemische und hämatologische Parameter wurden kontinuierlich erhoben. Die SOFA Scores wurden alle 2 Tagen errechnet.

Die verstorbenen Patienten hatten einen höheren APACHE II Score, sowie ein niedrigeres Albumin am 3. Tag und ein höheres CRP am 6. Tag. Statistisch bestand kein signifikanter Unterschied im Vergleich des CRP, des Fibrinogens, des Albumins, der Plasmaproteine bzw. der Neutrophilen und Lymphozyten Zahl aller Subgruppen während der 6 Beobachtungstage. Die Leukozytenzahl war am 6. Tag statistisch signifikant unterschiedlich. Die Aktivität der Glutathionperoxidase (GPx) und der Glutathionreduktase war in den Selen-Subgruppen während der Therapie erhöht mit einer negativen Korrelation in den Placebo-Untergruppen.

Ein Abwärtstrend der SOD Aktivität, der in den Selen-Untergruppen deutlicher war, schien eine Folge einer geringeren Produktion von Superoxyd Radikalen zu sein. Wahrscheinlich ist das aber eher auf eine Wiederherstellung der GPx Aktivität (die vor einer weiteren Peroxydation der organischen Substrate und einer zyklischen Bildung von anderen Radikalen schützt) als auf eine tatsächliche Verminderung ihrer Produktion zurückzuführen.

Substitution mit Selen erhöhte die Aktivität der Selen-abhängigen antioxidativen Enzyme. Ein Vergleich der Mortalität beider Gruppen ergab eine um 16,7 % niedrigere Sterberate der mit Selen behandelten Patienten.

Schlüsselwörter

Oxidativer Stress Sepsis Selen Künstliche Ernährung 

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Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Vašková Janka
    • 1
  • Kočan Ladislav
    • 2
  • Firment Jozef
    • 2
  • Vaško Ladislav
    • 1
  1. 1.Institute of Medical and Clinical Biochemistry, Faculty of MedicinePavol Jozef Šafárik University in KošiceKošiceSlovak Republic
  2. 2.1st Clinic of Anaesthesiology and Intensive Care MedicineLouis Pasteur University Hospital in KošiceKošiceSlovak Republic

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