Serum selenium and selenoprotein P concentrations drop to very low levels very quickly following major traumatic injury. The very low selenium and selenoprotein P levels are associated with poor survival odds [Braunstein].
These findings in a study done at the University Hospital in Munich, Germany, suggest that selenium supplementation may be a meaningful adjuvant treatment strategy for patients who have suffered major trauma [Braunstein].
Selenium and Critical Illness
Lower than normal selenium status is characteristic of critical illness. Low selenium status can affect the course and the outcome of various diseases [Braunstein].
For example, Bomer et al [2019] found that heart failure patients with serum selenium levels below 70 micrograms per liter had poorer quality of life, poorer exercise capacity, and poorer prognosis than heart failure patients with higher serum selenium levels.
Heart failure patients with serum selenium concentrations between 70 and 100 micrograms per liter had adverse exercise capacity and adverse quality of life conditions almost as bad as the conditions of the heart failure patients whose serum selenium levels were below 70 micrograms per liter [Bomer].
Another example: Hurst et al [2012] summarized 12 studies enrolling 13,254 participants in selenium supplementation and prostate cancer studies. They found that the risk of prostate cancer declined as serum or plasma selenium levels rose from 60 to 170 micrograms of selenium per liter [Hurst]. In other words, there was a higher risk of prostate cancer in men with low serum selenium concentrations.
The researchers concluded that serum or plasma selenium levels between 120 and 170 micrograms of selenium per liter have the greatest potential for reducing the risk of prostate cancer [Hurst].
U-shaped Relationship Between Selenium Status and Health
Professor Margaret P. Rayman has proposed that a U-shaped relationship exists between selenium status and health or disease. Her analysis of the relevant data is that the bottom of the U is at a serum selenium concentration of about 125 micrograms per liter [Rayman].
The evidence from the Bomer study of heart failure patients (worse prognosis in patients below 100 micrograms of selenium per liter) and the evidence from the Hurst study of prostate cancer patients (worse prognosis in patients below 120 micrograms of selenium per liter) ties in nicely with the Rayman hypothesis.
Selenium Status and Major Trauma
In the Munich, Germany, study, the researchers determined the serum selenium and selenoprotein P status of trauma patients with a mean injury severity score of 43 ± 14 (range: 21-75) [Braunstein].
Note: Injury severity scores above 15 indicate major trauma.
Compared to serum selenium levels in a large cohort of normal healthy Europeans, the trauma patients’ serum selenium and selenoprotein P levels were significantly lower at all times from one hour until 72 hours after the trauma. The concentrations were lowest one hour after the trauma (the earliest measurement), increased gradually in the period up to 12 hours following the trauma, and then declined again [Braunstein].
Serum Selenium Levels Related to 90-Day Survival
The major trauma patients who died had both lower serum selenium and lower serum selenoprotein P levels compared to surviving patients.
Serum Selenium and Selenoprotein P Decline After Major Trauma
- Both serum selenium levels and serum selenoprotein levels were extremely low within the first 60 minutes after the trauma. This indicates that the drastic changes in selenium and selenoprotein P status must have taken place immediately in response to the injury.
- There must have been a very fast and very strong uptake of the selenoprotein P from the blood into the target cells immediately after the traumatic injury.
- Severe injury triggers oxidative stress and a systemic inflammatory response. The decline in serum selenium and selenoprotein P observed in the major trauma patients must logically be associated with increased free radical production and increased inflammation resulting from the traumatic injury.
- A sufficiently high serum selenium status is needed for the bio-synthesis of the glutathione peroxidases, thioredoxin reductases, and other antioxidative seleno-enzymes that make possible an adequate response to oxidative stress.
Hence the case for urgent selenium supplementation of major trauma patients is made. Early extra selenium supply might enhance the bio-synthesis of selenoprotein P in the early stages of injury treatment.
Evidence for Rapid Selenium Supplementation of Critically Ill Patients
- Khalili et al [2017] showed that intravenous selenium treatment gave a significant improvement in functional neurological outcome in traumatic brain injury patients. The effect persisted at six months following discharge.
- Berger et al [2008] showed that an intervention with selenium, zinc, and glutathione reduced the extent of systemic inflammation but not early organ dysfunction in trauma and surgery patients.
- Angstwurm et al [2007] showed that 1000 micrograms of sodium-selenite as a 30-min bolus injection followed by 14 daily continuous infusions of 1000 micrograms of intravenously reduced the mortality rate in patients with severe sepsis or septic shock.
- Kuklinski et al [1994] randomly assigned heart attack patients, immediately after hospitalization, to an adjunctive treatment group (n = 32) to receive 500 micrograms of selenium as sodium selenite (intramuscular injection) and 100 milligrams of Coenzyme Q10 (oral administration) on admission not later than 6 hours after the onset of symptoms. Thereafter, these patients were given oral administrations of 100 milligrams of Coenzyme Q10 and 1oo micrograms of selenium (in the form of l-selenomethionine), 15 milligrams of zinc, 1 milligram of vitamin A, 2 milligrams of vitamin B6, 90 milligrams of vitamin C, and 15 milligrams of vitamin E for a period of one year. 29 other heart attack patients were given matching placebos for one year. The adjunctive antioxidant treatment improved the long-term prognosis following the heart attack [Kuklinski].
Conclusion
Early intervention with first intravenous selenium and then oral selenium administration may be a meaningful adjuvant treatment for trauma patients, critically ill patients, and surgery patients. Initiation of adjunctive treatment with selenium (and other antioxidants) must be started as soon as possible if it is going to have a significant effect.
Sources
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Berger MM, Soguel L, Shenkin A, Revelly JP, Pinget C, Baines M & Chiolero RL. (2008). Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients. Crit Care;12(4):R101.
Bomer N, Grote Beverborg N, Hoes MF, Streng KW, Vermeer M, Dokter MM, IJmker J, Anker SD, Cleland JGF, Hillege HL, Lang CC, Ng LL, Samani NJ, Tromp J, van Veldhuisen DJ, Touw DJ, Voors AA & van der Meer P. (2019). Selenium and outcome in heart failure. Eur J Heart Fail. 2019 Dec 6. doi: 10.1002/ejhf.1644. [Epub ahead of print].
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Hurst R, Hooper L, Norat T, Lau R, Aune D, Greenwood DC & Fairweather-Tait, SJ (2012). Selenium and prostate cancer: systematic review and meta-analysis. The American Journal of Clinical Nutrition, 96(1), 111-122.
Khalili H, Ahl R, Cao Y, Paydar S, Sjölin G, Niakan A, Dabiri G & Mohseni S. (2017). Early selenium treatment for traumatic brain injury: Does it improve survival and functional outcome? Injury; 48(9):1922-1926.
Kuklinski B, Weissenbacher E & Fähnrich A. (1994). Coenzyme Q10 and Antioxidants in Acute Myocardial Infarction; Mol Aspects Med 1994 15s s143-s147
Rayman MP. (2019). Selenium intake, status, and health: a complex relationship. Hormones (Athens), https://doi.org/10.1007/s42000-019-00125-5.
The information presented in this review article is not intended as medical advice and should not be used as such.
16 February 2020