Treatment effect of intravenous high-dose selenium in sepsis phenotypes: a retrospective analysis of a large multicenter randomized controlled trial.

IF 3.8 2区 医学 Q1 CRITICAL CARE MEDICINE
David I Radke, Holger Bogatsch, Christoph Engel, Frank Bloos, Patrick Meybohm, Michael Bauer, Anna Lulu Homayr, Christian Stoppe, Gunnar Elke, Matthias Lindner
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引用次数: 0

Abstract

Background: Treatment effect of high-dose intravenous selenium remains controversial in patients with sepsis or septic shock. Here, we reanalyzed data from the randomized placebo-controlled trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT) to reveal possible treatment differences according to established sepsis phenotypes.

Methods: In this secondary data analysis of the SISPCT trial all 1089 patients of the original study were included. Patients were assigned to one of the four phenotypes by comparing patient variables with the Sepsis Endotyping in Emergency Care (SENECA) validation cohort. Survival analyses were performed using Kaplan-Meier and log-rank tests.

Results: No robust effect of selenium on mortality and other outcome parameters could be determined in any sepsis phenotype. Phenotype frequencies were markedly different in our study cohort compared to previous reports (α: 2.2%, β: 6.3%, γ: 68.0%, δ: 23.4%). Differences in mortality between the respective phenotypes were not significant overall; however, 28-day mortality showed a lower mortality for the α- (20.8%) and β-phenotype (20.3%), followed by the γ- (27.1%), and δ-phenotype (28.5%).

Conclusions: Application of the four sepsis phenotypes to the SISPCT study cohort showed discrete but non-significant mortality differences within 28 days. However, beneficial treatment effects of high-dose intravenous selenium were still not detectable after categorizing the SISPCT study cohort according to four phenotype criteria.

静脉注射大剂量硒治疗脓毒症的疗效:一项大型多中心随机对照试验的回顾性分析。
背景:大剂量静脉注射硒对脓毒症或感染性休克的治疗效果仍有争议。在这里,我们重新分析了亚硒酸钠和降钙素原引导的严重脓毒症(SISPCT)抗菌治疗的随机安慰剂对照试验数据,以揭示根据已建立的脓毒症表型可能存在的治疗差异。方法:在SISPCT试验的次要数据分析中,纳入了原始研究的所有1089例患者。通过将患者变量与急诊脓毒症内分型(SENECA)验证队列进行比较,将患者分配到四种表型中的一种。生存分析采用Kaplan-Meier检验和log-rank检验。结果:在任何脓毒症表型中,硒对死亡率和其他结局参数都没有明显的影响。表型频率在我们的研究队列中与之前的报道相比有显著差异(α: 2.2%, β: 6.3%, γ: 68.0%, δ: 23.4%)。各表型间的死亡率总体上差异不显著;28天死亡率中,α-型(20.8%)和β-型(20.3%)死亡率较低,其次是γ-型(27.1%)和δ-型(28.5%)。结论:将四种脓毒症表型应用于SISPCT研究队列显示,28天内的死亡率存在离散但不显著的差异。然而,根据四种表型标准对SISPCT研究队列进行分类后,仍未检测到高剂量静脉注射硒的有益治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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