Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan.
PLoS One. 2013;8(1):e54431. doi: 10.1371/journal.pone.0054431. Epub 2013 Jan 25.
It is currently unclear whether parenteral selenium supplementation should be recommended in the management of critically ill patients. Here we conducted a systematic review and meta-analysis to assess the efficacy of parenteral selenium supplementation on clinical outcomes.
METHODS/PRINCIPAL FINDINGS: Randomized trials investigating parenteral selenium supplementation administered in addition to standard of care to critically ill patients were included. CENTRAL, Medline, EMBASE, the Science Citation Index, and CINAHL were searched with complementary manual searches. The primary outcome was all-cause mortality. Trials published in any language were included. Two authors independently extracted data and assessed trial quality. A third author was consulted to resolve disagreements and for quality assurance. Twelve trials were included and meta-analysis was performed on nine trials that recruited critically ill septic patients. These comprised 965 participants in total. Of these, 148 patients (30.7%) in the treatment groups, and 180 patients (37.3%) in control groups died. Parenteral selenium treatment significantly reduced all-cause mortality in critically ill patients with sepsis (relative risk [RR] 0.83, 95% CI 0.70-0.99, p = 0.04, I(2) = 0%). Subgroup analyses demonstrated that the administration schedule employing longer duration (RR 0.77, 95% CI 0.63-0.94, p = 0.01, I(2) = 0%), loading boluses (RR 0.73, 95% CI 0.58-0.94, p = 0.01, I(2) = 0%) or high-dose selenium treatment (RR 0.77, 95% CI 0.61-0.99, p = 0.04, I(2) = 0%) might be associated with a lower mortality risk. There was no evidence of adverse events.
CONCLUSIONS/SIGNIFICANCE: Parenteral selenium supplementation reduces risk of mortality among critically ill patients with sepsis. Owing to the varied methodological quality of the studies, future high-quality randomized trials that directly focus on the effect of adequate-duration of parenteral selenium supplementation for severe septic patients are needed to confirm our results. Clinicians should consider these findings when treating this high-risk population.
PROSPERO 2011; CRD42011001768.
目前尚不清楚是否应推荐在危重病患者的治疗中进行静脉注射硒补充。我们在这里进行了一项系统评价和荟萃分析，以评估静脉注射硒补充对临床结局的疗效。
方法/主要发现：纳入了研究静脉注射硒补充剂联合标准治疗用于危重病患者的随机试验。我们在 CENTRAL、Medline、EMBASE、科学引文索引和 CINAHL 进行了检索，并辅以补充的手工检索。主要结局是全因死亡率。纳入了以任何语言发表的试验。两位作者独立提取数据并评估了试验质量。对于分歧和质量保证，我们咨询了第三位作者。纳入了 12 项试验，对招募危重症脓毒症患者的 9 项试验进行了荟萃分析。这些试验共纳入了 965 名患者。其中，治疗组 148 名患者（30.7%）和对照组 180 名患者（37.3%）死亡。静脉注射硒治疗可显著降低脓毒症危重病患者的全因死亡率（相对风险 [RR] 0.83，95% CI 0.70-0.99，p=0.04，I(2)=0%）。亚组分析表明，采用较长时间（RR 0.77，95% CI 0.63-0.94，p=0.01，I(2)=0%）、负荷剂量（RR 0.73，95% CI 0.58-0.94，p=0.01，I(2)=0%）或高剂量硒治疗（RR 0.77，95% CI 0.61-0.99，p=0.04，I(2)=0%）的方案可能与较低的死亡率风险相关。没有证据表明有不良事件。
结论/意义：静脉注射硒补充可降低脓毒症危重病患者的死亡率。由于研究的方法学质量存在差异，因此需要未来进行高质量的随机试验，直接关注给予危重症严重脓毒症患者足够时间的静脉注射硒补充的效果，以证实我们的结果。临床医生在治疗这一高危人群时应考虑这些发现。
PROSPERO 2011；CRD42011001768。
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