Time course and relationship between plasma selenium concentrations, systemic inflammatory response, sepsis, and multiorgan failure.

BACKGROUND Selenium plays an important role in defence against acute illness. We investigated, in intensive care unit (ICU) patients, the time course of plasma selenium concentrations and their relationship to systemic inflammatory response syndrome (SIRS), organ dysfunction/failure, infection, and ICU outcome. METHODS Plasma selenium and laboratory indices of organ dysfunction/failure, tissue inflammation, and infection were measured daily during the ICU stay in 60 consecutive ICU patients, 15 in each of four a priori defined subgroups: ICU controls (no SIRS); uncomplicated SIRS; severe SIRS; and severe sepsis/septic shock. RESULTS Plasma selenium concentrations were below standard values for healthy subjects (74 microg litre(-1)) in 55 patients (92%). Selenium concentrations decreased during the ICU stay in all groups, except controls, to a minimum value that was lower in patients with organ failure, particularly in those with infection. The minimum plasma selenium was inversely correlated to admission Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology System II scores, indicators of inflammation, and the maximal degree of organ dysfunction/failure during the ICU stay. Plasma selenium was positively correlated with minimum platelet count, minimum plasma antithrombin activity, and protein C activity. In a receiver operator characteristic analysis, SAPS II score [area under the curve (AUC) = 0.903] and minimum selenium concentration (AUC = 0.867) were the strongest predictive factors for ICU mortality. CONCLUSIONS In critically ill surgical patients, plasma selenium concentrations are generally low with a greater decrease during the ICU stay in patients with organ failure, especially when attributed to infection. Lower plasma selenium concentrations are associated with more tissue damage, the presence of infection or organ dysfunction/failure, and increased ICU mortality.