Effects of high doses of selenium, as sodium selenite, in septic shock: a placebo-controlled, randomized, double-blind, phase II study

Xavier Forceville, Bruno Laviolle, Djillali Annane, Dominique Vitoux, Gérard Bleichner, Jean-Michel Korach, Emmanuel Cantais, Hugues Georges, Jean-Louis Soubirou, Alain Combes, Eric Bellissant, Xavier Forceville, Bruno Laviolle, Djillali Annane, Dominique Vitoux, Gérard Bleichner, Jean-Michel Korach, Emmanuel Cantais, Hugues Georges, Jean-Louis Soubirou, Alain Combes, Eric Bellissant

Abstract

Introduction: Sepsis is associated with the generation of oxygen free radicals and (lacking) decreased selenium plasma concentrations. High doses of sodium selenite might reduce inflammation by a direct pro-oxidative effect and may increase antioxidant cell capacities by selenium incorporation into selenoenzymes. We investigated the effects of a continuous administration of high doses of selenium in septic shock patients.

Methods: A prospective, multicentre, placebo-controlled, randomized, double-blind study was performed with an intention-to-treat analysis in severe septic shock patients with documented infection. Patients received, for 10 days, selenium as sodium selenite (4,000 microg on the first day, 1,000 microg/day on the nine following days) or matching placebo using continuous intravenous infusion. The primary endpoint was the time to vasopressor therapy withdrawal. The duration of mechanical ventilation, the mortality rates in the intensive care unit, at hospital discharge, and at 7, 14, 28 and 180 days and 1 year after randomization, and adverse events were recorded.

Results: Sixty patients were included (placebo, n = 29; selenium, n = 31). The median time to vasopressor therapy withdrawal was 7 days in both groups (95% confidence interval = 5-8 and 6-9 in the placebo and selenium groups, respectively; log-rank, P = 0.713). The median duration of mechanical ventilation was 14 days and 19 days in the placebo and selenium groups, respectively (P = 0.762). Mortality rates did not significantly differ between groups at any time point. Rates of adverse events were similar in the two groups.

Conclusion: Continuous infusion of selenium as sodium selenite (4,000 microg on the first day, 1,000 microg/day on the nine following days) had no obvious toxicity but did not improve the clinical outcome in septic shock patients. Trial Registration = NCT00207844.

Figures

Figure 1
Figure 1
The participant flow diagram. *Use of data was permitted by the patient.
Figure 2
Figure 2
Time to vasopressor therapy withdrawal.
Figure 3
Figure 3
One year survival distribution. Mortality rates were 45% vs. 45% (p = 0.59), on day 28; 59% vs. 68% (p = 0.32) at 6 month; and 66% vs. 71% (p = 0.43) at one year in the placebo and selenium groups, respectively.

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