Low plasma selenium concentrations are common in critically ill patients.
•But it is not clear to what extent they reflect deficiency or systemic inflammation.
•Unlike plasma selenium, red cell selenium does not change in acute-phase response.
•Red cell concentration is a marker of selenium status during systemic inflammation.
•Selenoprotein P is associated with red cell selenium in the acute-phase response.
AbstractObjectivesPlasma selenium may not reflect selenium status in critically ill patients because it transiently decreases inversely with the magnitude of the systemic inflammatory response. The decision to supplement selenium should ideally be based on laboratory measurements that reliably reflect selenium status. We hypothesized that erythrocyte selenium, unlike plasma selenium, is not affected by the systemic inflammatory response in critically ill children.
MethodsIn a prospective study of 109 critically ill children, plasma and erythrocyte selenium concentrations were evaluated on admission, and plasma selenoprotein P was evaluated on days 1, 2, and 3 of the ICU stay. The main outcome was the effect of systemic inflammation on the erythrocyte and plasma selenium concentrations. The magnitude of the systemic inflammatory response was measured using serum C-reactive protein (CRP) and procalcitonin levels. The covariates were age, sex, anthropometric nutritional status, diagnosis of severe sepsis/septic shock, and clinical severity on admission. Multiple linear regression and generalized estimating equations were used for statistical analysis.
ResultsErythrocyte selenium levels were not influenced by the magnitude of the inflammatory response or by the patient’s clinical severity. Procalcitonin (β coefficient=−0.99; 95%CI: −1.64; −0.34, p = 0.003) and clinical severity (β coefficient= −11.13; 95%CI: −21.6; −0.63), p = 0.038) on admission were associated with decreased plasma selenium concentrations. Erythrocyte selenium was associated with selenoprotein P in the first three days of ICU stay (β coefficient=0.32; 95%CI: 0.20; 0.44, p < 0.001).
ConclusionUnlike plasma selenium, erythrocyte selenium does not change in children with an acute systemic inflammatory response and is associated with selenoprotein P concentrations. Erythrocyte selenium is probably a more reliable marker than plasma selenium for evaluating the selenium status in critically ill children.
AbbreviationsBMI/Abody mass index-for-age
GEEGeneralized Estimating Equations
PELOD-2Pediatric Logistic Organ Dysfunction-2 score
PIM 2Revised Pediatric Index of Mortality
SIRSSystemic Inflammatory Response Syndrome
WHOWorld Health Organization
KeywordsNutritional status
Selenium
Selenoprotein P
Systemic inflammatory response syndrome
Intensive care unit, pediatric
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