Zhao Yan, Yang Mengmeng, Mao Zhi, Yuan Rui, Wang Li, Hu Xin, Zhou Feihu, Kang Hongjun
Department of Critical Care Medicine, Chinese PLA General Hospital, Beijing, China.
Medicine (Baltimore). 2019 May;98(20):e15473. doi: 10.1097/MD.0000000000015473.
Selenium supplementation is a potentially promising adjunctive therapy for critically ill patients, but the results are controversy among studies. Accordingly, we performed this meta-analysis to more clearly detect the efficacy and safety of selenium supplementation on critically ill patients.
Systematic literature retrieval was carried out to obtain RCTs on selenium supplementation for critically ill patients up to August 2017. Data extraction and quality evaluation of these studies were performed by 2 investigators. Statistical analyses was performed by RevMan 5.3. Trial sequential analysis (TSA) was conducted to control the risks of type I and type II errors and calculate required information size (RIS).
Totally 19 RCTs involving 3341 critically ill patients were carried out in which 1694 participates were in the selenium supplementation group, and 1647 in the control. The aggregated results suggested that compared with the control, intravenous selenium supplement as a single therapy could decrease the total mortality (RR = 0.86, 95% CI: 0.78-0.95, P = .002, TSA-adjusted 95% CI = 0.77-0.96, RIS = 4108, n = 3297) and may shorten the length of stay in hospital (MD -2.30, 95% CI -4.03 to -0.57, P = .009), but had no significant treatment effect on 28-days mortality (RR = 0.96, 95% CI: 0.85-1.09, P = .54) and could not shorten the length of ICU stay (MD -0.15, 95% CI -1.68 to 1.38, P = .84) in critically ill patients. Our results also showed that selenium supplementation did not increase incidence of drug-induced side effect compared with the control (RR 1.04, 95% CI 0.83 to 1.30, P = .73).
The current evidence suggests that the use of selenium could reduce the total mortality, and TSA results showed that our outcome is reliable and no more randomized controlled trials are needed. But selenium supplementation might have no effect on reducing 28-days mortality as well as the incidence of new infections, or on length of stay in ICU or mechanical ventilation. However, the results should be used carefully because of potential limitations.
补充硒对重症患者而言是一种潜在的、有前景的辅助治疗方法，但各研究结果存在争议。因此，我们进行了这项荟萃分析，以更明确地探究补充硒对重症患者的疗效和安全性。
进行系统的文献检索，以获取截至2017年8月关于补充硒治疗重症患者的随机对照试验。由两名研究人员对这些研究进行数据提取和质量评估。使用RevMan 5.3进行统计分析。进行试验序贯分析（TSA）以控制I型和II型错误的风险，并计算所需信息量（RIS）。
共开展了19项涉及3341例重症患者的随机对照试验，其中1694例参与者在补充硒组，1647例在对照组。汇总结果表明，与对照组相比，静脉补充硒作为单一疗法可降低总死亡率（RR = 0.86，95% CI：0.78 - 0.95，P = 0.002，TSA调整后的95% CI = 0.77 - 0.96，RIS = 4108，n = 3297），并可能缩短住院时间（MD -2.30，95% CI -4.03至-0.57，P = 0.009），但对28天死亡率无显著治疗效果（RR = 0.96，95% CI：0.85 - 1.09，P = 0.54），且不能缩短重症患者的重症监护病房住院时间（MD -0.15，95% CI -1.68至1.38，P = 0.84）。我们的结果还表明，与对照组相比，补充硒不会增加药物引起的副作用发生率（RR 1.04，95% CI 0.83至1.30，P = 0.73）。
当前证据表明，使用硒可降低总死亡率，TSA结果表明我们的结果可靠，无需更多随机对照试验。但补充硒可能对降低28天死亡率以及新发感染发生率、重症监护病房住院时间或机械通气时间无影响。然而，由于存在潜在局限性，这些结果应谨慎使用。
