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de Man AME, Amrein K, Casaer MP, Dizdar OS, van Zanten ARH, Gundogan K, Lepp L, Rezzi S, Shenkin A, Berger MM. LLL 44-4 : Micronutrients in acute disease and critical illness. Clin Nutr ESPEN 2024; 61:437-446. [PMID: 38777466 DOI: 10.1016/j.clnesp.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
Micronutrients (MN), i.e. trace elements and vitamins, are essential components of the diet in relatively small amounts in any form of nutrition, with special needs in critically ill patients. Critical illness is characterised by the presence of inflammation and oxidative stress. MNs are tightly involved in antioxidant and immune defences. In addition, some conditions, and treatments result in large losses of biological fluids containing MNs: therefore, acute renal injury requiring renal replacement therapy, acute intestinal failure, and major burns and trauma are at high risk of acute depletion of body stores, and of deficiency. MN requirements are increased above standard DRI. Blood level interpretation is complicated by inflammation: some biomarkers assist the status determination. Due to the acute challenges of critical illness, it of utmost importance to cover the needs to maintain the organism's endogenous immune and antioxidant defences, and capacity to repair tissues. Practical strategies are proposed.
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Affiliation(s)
- Angélique M E de Man
- Amsterdam UMC, Location Vrije Universiteit, Department of Intensive Care, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
| | - Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Diabetology, Austria.
| | - Michael P Casaer
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
| | - Oguzhan S Dizdar
- Department of Internal Medicine and Clinical Nutrition Unit, University of Health Sciences Kayseri City Training and Research Hospital, Kayseri, Turkey.
| | - Arthur R H van Zanten
- Gelderse Vallei Hospital, Ede and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey; North Estonia Regional Hospital, Tallinn, Estonia.
| | - Liis Lepp
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.
| | - Serge Rezzi
- Swiss Nutrition and Health Foundation, Epalinges, Switzerland.
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Mette M Berger
- Faculty of Biology & Medicine, Lausanne University, Lausanne, Switzerland.
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Stoppe C, Elke G, Silvstre SCDM, Kappus M. Highlights in the clinical nutrition literature: A critical appraisal of current research. JPEN J Parenter Enteral Nutr 2024; 48:377-388. [PMID: 38310478 DOI: 10.1002/jpen.2599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 02/05/2024]
Abstract
Within the American Society for Parenteral and Enteral Nutrition (ASPEN), the Physician Engagement Committee (PEC) was created in 2017 by the ASPEN Board of Directors with the goal of growing the physician community both nationally and internationally. The PEC meets each month throughout the year to develop educational and research initiatives. In 2022, the PEC began an initiative to systematically review and evaluate practice-changing literature annually with the overall aim to highlight these studies at the annual ASPEN conferences and to critically discuss the potential clinical implications. The objective of the held meeting session was to present identified key papers in the fields of critical care medicine, gastroenterology and hepatology, and adult internal medicine that were published in 2022, which would complement the knowledge of the pathogenesis, diagnosis, and management of nutrition topics as well as to identify areas of future research. Overall, several large-scale randomized controlled studies were identified in each of these sections, with practice-changing major results. This manuscript summarizes the information that was presented and the discussions that followed.
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Affiliation(s)
- Christian Stoppe
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
- Department of Cardiac Anesthesiology & Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Matthew Kappus
- Division of Gastroenterology and Hepatology, Duke University Health, Durham, North Carolina, USA
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Sarhan AM, Awad AK, Alassiri AK, Abd-Alkhaleq MS, Al-Asmar R, Gonnah AR. Efficacy of selenium on patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials. J Cardiothorac Surg 2024; 19:264. [PMID: 38659018 PMCID: PMC11040970 DOI: 10.1186/s13019-024-02761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/30/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Postoperative complications pose significant challenges in cardiac surgery and with the evolution of selenium as a potential anti-inflammatory agent, some studies reported its inefficiency. Thus, we conducted our meta-analysis to evaluate the impact of selenium supplementation on cardiac surgery patients. METHODS Different databases such as PubMed, Embase, and Cochrane Library from inception till January 2024 were searched identifying a total of seven randomized-controlled trials involving selenium supplementation after cardiac surgery. Risk ratio (RR) and Mean difference (MD) were calculated with a 95% confidence interval (CI). RESULTS The selenium intervention significantly raised the incidence of Acute Kidney injury (RR 0.76; 95% CI: 0.59, 0.98; P = 0.04) while significantly reducing the duration of hospital stay (MD -1.33; 95% CI: -2.51, -0.16; P = 0.03) and postoperative CRP levels (SMD -0.18; 95% CI: -0.34, -0.02; P = 0.03). The effect of selenium intervention on days spent in ICU (MD -0.01; 95% CI: -0.28, 0.25; P = 0.92), mortality (RR 1.07; 95% CI: 0.84, 1.37; P = 0.57) and incidence of hospital acquired infections (RR 0.98; 95% CI: 0.76, 1.26; P = 0.88) is insignificant. CONCLUSION Selenium supplementation did not significantly reduce major postoperative complications in cardiac surgery patients. However, its ability to modulate inflammation, as reflected in decreased C-reactive protein levels, highlights its potential role in managing the inflammatory response. Future investigations should focus on optimized selenium supplementation strategies in conjunction with other antioxidants to enhance its benefits.
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Affiliation(s)
- Ahmed M Sarhan
- Faculty of Medicine, October 6 University, Cairo, Egypt.
| | - Ahmed K Awad
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Demircan K, Chillon TS, Bang J, Gladyshev VN, Schomburg L. Selenium, diabetes, and their intricate sex-specific relationship. Trends Endocrinol Metab 2024:S1043-2760(24)00066-3. [PMID: 38599899 DOI: 10.1016/j.tem.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
Selenium (Se) is an essential trace element, which is inserted as selenocysteine (Sec) into selenoproteins during biosynthesis, orchestrating their expression and activity. Se is associated with both beneficial and detrimental health effects; deficient supply or uncontrolled supplementation raises concerns. In particular, Se was associated with an increased incidence of type 2 diabetes (T2D) in a secondary analysis of a randomized controlled trial (RCT). In this review, we discuss the intricate relationship between Se and diabetes and the limitations of the available clinical and experimental studies. Recent evidence points to sexual dimorphism and an association of Se deficiency with gestational diabetes mellitus (GDM). We highlight the emerging evidence linking high Se status with improved prognosis in patients with T2D and lower risk of macrovascular complications.
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Affiliation(s)
- Kamil Demircan
- Institute for Experimental Endocrinology, Max Rubner Center, Charité University Berlin, Germany
| | - Thilo Samson Chillon
- Institute for Experimental Endocrinology, Max Rubner Center, Charité University Berlin, Germany
| | - Jeyoung Bang
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Vadim N Gladyshev
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Max Rubner Center, Charité University Berlin, Germany.
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Stoppe C, Dresen E, de Man A. Micronutrients as therapy in critical illness. Curr Opin Crit Care 2024; 30:178-185. [PMID: 38441190 DOI: 10.1097/mcc.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW Recent large-scale randomized controlled trials (RCTs) challenged current beliefs about the potential role of micronutrients to attenuate the inflammatory response and improve clinical outcomes of critically ill patients. The purpose of this narrative review is to provide an overview and critical discussion about most recent clinical trials, which evaluated the clinical significance of a vitamin C, vitamin D, or selenium administration in critically ill patients. RECENT FINDINGS None of the most recent large-scale RCTs could demonstrate any clinical benefits for a micronutrient administration in ICU patients, whereas a recent RCT indicated harmful effects, if high dose vitamin C was administered in septic patients. Following meta-analyses could not confirm harmful effects for high dose vitamin C in general critically ill patients and indicated benefits in the subgroup of general ICU patients with higher mortality risk. For vitamin D, the most recent large-scale RCT could not demonstrate clinical benefits for critically ill patients, whereas another large-scale RCT is still ongoing. The aggregated and meta-analyzed evidence highlighted a potential role for intravenous vitamin D administration, which encourages further research. In high-risk cardiac surgery patients, a perioperative application of high-dose selenium was unable to improve patients' outcome. The observed increase of selenium levels in the patients' blood did not translate into an increase of antioxidative or anti-inflammatory enzymes, which illuminates the urgent need for more research to identify potential confounding factors. SUMMARY Current data received from most recent large-scale RCTs could not demonstrate clinically meaningful effects of an intervention with either vitamin C, vitamin D, or selenium in critically ill patients. More attention is needed to carefully identify potential confounding factors and to better evaluate the role of timing, duration, and combined strategies.
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Affiliation(s)
- Christian Stoppe
- University Hospital Wuerzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, German Heart Center Charité Berlin, Berlin, Germany
| | - Ellen Dresen
- University Hospital Wuerzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
| | - Angelique de Man
- Department of Intensive Care, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Angelone T, Rocca C, Lionetti V, Penna C, Pagliaro P. Expanding the Frontiers of Guardian Antioxidant Selenoproteins in Cardiovascular Pathophysiology. Antioxid Redox Signal 2024; 40:369-432. [PMID: 38299513 DOI: 10.1089/ars.2023.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Significance: Physiological levels of reactive oxygen and nitrogen species (ROS/RNS) function as fundamental messengers for many cellular and developmental processes in the cardiovascular system. ROS/RNS involved in cardiac redox-signaling originate from diverse sources, and their levels are tightly controlled by key endogenous antioxidant systems that counteract their accumulation. However, dysregulated redox-stress resulting from inefficient removal of ROS/RNS leads to inflammation, mitochondrial dysfunction, and cell death, contributing to the development and progression of cardiovascular disease (CVD). Recent Advances: Basic and clinical studies demonstrate the critical role of selenium (Se) and selenoproteins (unique proteins that incorporate Se into their active site in the form of the 21st proteinogenic amino acid selenocysteine [Sec]), including glutathione peroxidase and thioredoxin reductase, in cardiovascular redox homeostasis, representing a first-line enzymatic antioxidant defense of the heart. Increasing attention has been paid to emerging selenoproteins in the endoplasmic reticulum (ER) (i.e., a multifunctional intracellular organelle whose disruption triggers cardiac inflammation and oxidative stress, leading to multiple CVD), which are crucially involved in redox balance, antioxidant activity, and calcium and ER homeostasis. Critical Issues: This review focuses on endogenous antioxidant strategies with therapeutic potential, particularly selenoproteins, which are very promising but deserve more detailed and clinical studies. Future Directions: The importance of selective selenoproteins in embryonic development and the consequences of their mutations and inborn errors highlight the need to improve knowledge of their biological function in myocardial redox signaling. This could facilitate the development of personalized approaches for the diagnosis, prevention, and treatment of CVD. Antioxid. Redox Signal. 40, 369-432.
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Affiliation(s)
- Tommaso Angelone
- Cellular and Molecular Cardiovascular Pathophysiology Laboratory, Department of Biology, Ecology and Earth Sciences (DiBEST), University of Calabria, Rende, Italy
- National Institute of Cardiovascular Research (INRC), Bologna, Italy
| | - Carmine Rocca
- Cellular and Molecular Cardiovascular Pathophysiology Laboratory, Department of Biology, Ecology and Earth Sciences (DiBEST), University of Calabria, Rende, Italy
| | - Vincenzo Lionetti
- Unit of Translational Critical Care Medicine, Laboratory of Basic and Applied Medical Sciences, Interdisciplinary Research Center "Health Science," Scuola Superiore Sant'Anna, Pisa, Italy
- UOSVD Anesthesiology and Intensive Care Medicine, Fondazione Toscana "Gabriele Monasterio," Pisa, Italy
| | - Claudia Penna
- National Institute of Cardiovascular Research (INRC), Bologna, Italy
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Pasquale Pagliaro
- National Institute of Cardiovascular Research (INRC), Bologna, Italy
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
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Demircan K, Jensen RC, Chillon TS, Jensen TK, Sun Q, Bonnema SJ, Hackler J, Korevaar TIM, Glintborg D, Schomburg L, Andersen MS. Serum selenium, selenoprotein P, and glutathione peroxidase 3 during early and late pregnancy in association with gestational diabetes mellitus: Prospective Odense Child Cohort. Am J Clin Nutr 2023; 118:1224-1234. [PMID: 37813341 DOI: 10.1016/j.ajcnut.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Diet is an important modifiable risk factor for gestational diabetes mellitus (GDM) and its related complications; however, the role of essential micronutrients such as selenium (Se), particularly in populations with low Se intake, is inconclusive. OBJECTIVES The aim was to investigate the association of 3 established biomarkers of Se status with GDM, gestational glucose metabolism, and large for gestational-age offspring. METHODS This study included 1346 pregnant females with 2294 serum samples from the prospective, population-based Odense Child Cohort study, Denmark. Serum Se, selenoprotein P (SELENOP) concentrations, and glutathione peroxidase 3 (GPX3) activity were measured in early and late pregnancy, and fasting glucose and insulin assessments in late pregnancy. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was calculated, and the GDM definition was according to the WHO 2013 threshold of fasting venous plasma glucose of ≥5.1 mmol/L. A subcohort underwent an oral glucose tolerance test. Regression models adjusted for various confounders quantified dose-dependent associations. RESULTS Se and SELENOP declined during pregnancy. There were dose-dependent inverse associations of early GPX3 with late pregnancy GDM (WHO 2013), fasting glucose, insulin, HOMA-IR, and 2 h glucose. The odds ratio (OR) of GDM was 0.33 (95% CI: 0.16, 0.65) for 1 log-scale-increment in early GPX3 activity. Late pregnancy GPX3 and SELENOP were inversely associated with GDM and HOMA-IR; the OR of GDM was 0.21 (95% CI: 0.12, 0.38) and 0.52 (95% CI: 0.35, 0.77), for 1 log-scale-increment of GPX3 and SELENOP, respectively. A decline in Se biomarkers during pregnancy was associated with a higher risk of GDM and higher HOMA-IR. Low GPX3 activity in late pregnancy was associated with a higher risk of large for gestational-age offspring, partly (∼20%) mediated by fasting glucose concentrations (P = 0.006). CONCLUSIONS Low serum Se in pregnancy, particularly GPX3 activity, is independently associated with risk of GDM and large for gestational age. Offering Se status assessment in pregnancy identifies females at high risk for GDM who may benefit from Se substitution.
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Affiliation(s)
- Kamil Demircan
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Richard Christian Jensen
- Department of Endocrinology, Odense University Hospital, Kløvervænget, Odense C, and University of Southern Denmark, Odense, Denmark; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej, Odense C, Denmark
| | - Thilo Samson Chillon
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tina Kold Jensen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej, Odense C, Denmark; Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget, Odense C, Denmark; Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Qian Sun
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Kløvervænget, Odense C, and University of Southern Denmark, Odense, Denmark
| | - Julian Hackler
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Kløvervænget, Odense C, and University of Southern Denmark, Odense, Denmark
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, Kløvervænget, Odense C, and University of Southern Denmark, Odense, Denmark
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Demircan K, Hybsier S, Chillon TS, Vetter VM, Rijntjes E, Demuth I, Schomburg L. Sex-specific associations of serum selenium and selenoprotein P with type 2 diabetes mellitus and hypertension in the Berlin Aging Study II. Redox Biol 2023; 65:102823. [PMID: 37516012 PMCID: PMC10405093 DOI: 10.1016/j.redox.2023.102823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Selenium is essential for expression and proper function of a set of redox active selenoproteins implicated in aging-relevant diseases, e.g. type 2 diabetes mellitus (T2D) and hypertension. However, data in cohorts of older adults, particularly with respect to different Se biomarkers and sex-specific analyses are sparse. OBJECTIVE To assess associations of serum Se and selenoprotein P (SELENOP) concentrations with T2D and hypertension in a cohort of older females and males. METHODS This study included 1500 participants from the Berlin Aging Study II. Diagnosis of T2D was made in case of antidiabetic medication, self-reported T2D, or laboratory parameters. Diagnosis of hypertension was based on self-report, blood pressure measurement, or anti-hypertensive medication. Se was measured by spectroscopy, and SELENOP by ELISA. Multiple adjusted regression models quantified dose-dependent associations. RESULTS Participants had a median(IQR) age of 68 (65,71) years, and 767 (51%) were women. 191 (13%) participants had T2D and 1126 (75%) had hypertension. Se and SELENOP correlated significantly (r = 0.59, p < 0.001), and were elevated in those with self-reported Se supplementation. Serum Se and SELENOP were not associated with T2D in the whole cohort. In men, SELENOP was positively associated with T2D, OR (95%CI) for one mg/L increase in SELENOP was 1.22 (1.00,1.48). Se was non-linearly associated with hypertension, comparing to the lowest quartile (Q1), and participants with higher Se levels (Q3) had a lower OR (95%CI) of 0.66 (0.45,0.96), which was specific for men. SELENOP positively associated with hypertension, and OR (95%CI) per one mg/L increase was 1.15 (1.01,1.32). CONCLUSIONS The data suggest a sex-specific interrelationship of Se status with T2D and hypertension, with apparent biomarker-specific associations.
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Affiliation(s)
- Kamil Demircan
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Max Rubner Center (MRC) for Cardiovascular Metabolic Renal Research, D-10115, Berlin, Germany
| | - Sandra Hybsier
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Max Rubner Center (MRC) for Cardiovascular Metabolic Renal Research, D-10115, Berlin, Germany
| | - Thilo Samson Chillon
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Max Rubner Center (MRC) for Cardiovascular Metabolic Renal Research, D-10115, Berlin, Germany
| | - Valentin Max Vetter
- Department of Endocrinology and Metabolic Diseases (including Division of Lipid Metabolism), Biology of Aging Working Group, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, And Berlin Institute of Health (BIH), Berlin, Germany
| | - Eddy Rijntjes
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Max Rubner Center (MRC) for Cardiovascular Metabolic Renal Research, D-10115, Berlin, Germany
| | - Ilja Demuth
- Department of Endocrinology and Metabolic Diseases (including Division of Lipid Metabolism), Biology of Aging Working Group, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, And Berlin Institute of Health (BIH), Berlin, Germany.
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Max Rubner Center (MRC) for Cardiovascular Metabolic Renal Research, D-10115, Berlin, Germany.
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Rehan ST, Hussain HU, Imran L, Eqbal F, Asghar MS. Perioperative selenium administration in cardiac surgery patients, a way out to reduce post surgical adversities? A meta analysis. Front Cardiovasc Med 2023; 10:1235247. [PMID: 37711553 PMCID: PMC10497979 DOI: 10.3389/fcvm.2023.1235247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction The oxidative damage suffered in cardiac surgery is associated with declining trace elements which lead to the development of multi organ dysfunction (MOD), acute kidney injury (AKI), or increased length of hospital stay (LOS). Recent evidence shows the cardioprotective role of the trace element selenium as it mitigates worsening outcomes post cardiac surgery. Hence, this meta analysis aims to investigate the role of selenium in lowering cardiac surgery related adverse outcomes. Methods Literature search of five electronic databases was performed from the inception of the paper till 29th July, 2023. Eligibility criteria included; (a) randomized clinical trials with Adult patients (≥18 years) undergoing cardiac surgery (b) intervention with selenium pre or/and postoperatively; (c) a control group of a placebo, normal saline, or no selenium. Outcomes of interest include postoperative mortality, LOS in the hospital and Intensive Care Unit (ICU), AKI, troponin I, and Creatinine Kinase-MB (CK-MB). The Cochrane bias assessment tool was used to evaluate the risk of bias. Outcomes were pooled with the Mantel-Haenszel Random-effects model using Review Manager. Results Seven RCTs with 2,521 patients and 65% of males were included in this paper. No noticable differences were observed between selenium and control groups in terms of postoperative AKI, mortality, LOS in hospital and ICU, troponin I, and CK-MB levels. All studies had a low risk of bias on quality assessment. Discussion Our meta analysis demonstrated no discernible effects of selenium infusion on post operative complications among patients undergoing cardiac surgery. Further large scale multi centered studies comparing the protective role of selenium with combined therapy of other bioactive agents are needed to provide convincing explanations. Systematic Review Registration PROSPERO Identifier: 424920.
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Affiliation(s)
- Syeda Tayyaba Rehan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hassan Ul Hussain
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Laiba Imran
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Farea Eqbal
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Hill A. [Immunonutrition-In search of the optimum]. DIE ANAESTHESIOLOGIE 2023; 72:227-228. [PMID: 37017729 DOI: 10.1007/s00101-023-01276-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Aileen Hill
- Klinik für Anästhesiologie und Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Aachen, Deutschland.
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