Effect of Selenium Supplementation on CRP Levels and Incidence of Delirium in Critically Ill Patients

  • Babak Alikiaii Department of Anesthesiology and Intensive Care, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
  • Sarah Mousavi Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
  • Seyed Taghi Hashemi Department of Anesthesiology and Intensive Care, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
  • Mehran Abdollahi MD student, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Keywords: Selenium (Se), C-reactive protein, Delirium


Background: Selenium (Se), mainly through its incorporation into selenoproteins, plays an important role in inflammation and immunity. Evidence has emerged regarding roles for individual selenoproteins in regulating inflammation and immunity. The aim of this study was to evaluate the response on the inflammatory biomarker C-reactive protein, and its possible impact on the incidence of delirium.Methods: This prospective, non-randomized, open-label, single-center clinical trial included 100 critically ill patients. Patients in the Selenium group (n = 50) received Se for 5 days (500 μg twice daily infused over 2 hours). Plasma levels of C-reactive protein (CRP), was determined on days 1-5. The incidence of delirium was assessed by the Confusion Assessment Method (CAM) on a daily basis.Results: CRP decreased in the selenium group from day 1 onwards. The mean of CRP was 11.1 ± 2.20 in the Se group compared to 16.7±1.6 in the control group, the difference was significant (P < 0.0001). 32% of patients in the selenium group and 52% in the control group had delirium (P = 0.07).Conclusions: Se administration in critically ill patients decreased CRP levels, but did not reduce the incidence of delirium


Arumugam S, El-Menyar A, Al-Hassani A, et al. Delirium in the Intensive Care Unit. Journal of mergencies, Trauma, and Shock 2017;10(1):37-46.

Maldonado JR. Acute brain failure: pathophysiology, diagnosis, management, and sequelae of delirium. Crit Care Clinic 2017;33(3):461- 519.

Simone MJ, Tan ZS. The role of inflammation in the pathogenesis of delirium and dementia in older adults: a review. CNS Neurosci Ther 2011;17(5):506- 13.

Girard TD, Ware LB, Bernard GR, et al. Associations of markers of inflammation and coagulation with delirium during critical illness. Intensive Care Med 2012;38(12):1965-73.

Murray C, Sanderson DJ, Barkus C, et al. Systemic inflammation induces acute working memory deficits in the primed brain: relevance for delirium. Neurobiol Aging 2012 Mar;33(3):603-616.e3.

Sobbi SC, van den Boogaard M. Inflammation biomarkers and delirium in critically ill patients: new insights? Critical Care 2014;18(3):153.

Schreuder L, Eggen BJ, Biber KP, Schoemaker RG, Laman JD, de Rooij SE. Pathophysiological and behavioral effects of systemic inflammation in aged and diseased rodents with relevance to delirium: a systematic review. Brain Behav Immun 2017;62:362-381.

Zaal IJ, Devlin JW, Peelen LM, Slooter AJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med 2015;43(1):40-7

Van Gool WA, Van de Beek D, Eikelenboom P. Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet 2010;375(9716):773-5.

Ritter C, Tomasi CD, Dal-Pizzol F, et al. Inflammation biomarkers and delirium in critically ill patients. Crit Care 2014;18(3):R106.

Ritchie C, Newman T, Leurent B, Sampson E. The association between C-reactive protein and delirium in 710 acute elderly hospital admissions. Int Psychogeriatr 2014;26(5):717-24.

Huang TS, Shyu YC, Chen HY, et al. Effect of parenteral selenium supplementation in critically ill patients: a systematic review and meta-analysis. PLoS One 2013;8(1):e54431.

Manzanares W, Langlois PL, Heyland DK. Pharmaconutrition with selenium in critically ill patients: what do we know? Nutr Clin Pract 2015;30(1):34- 43.

McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr 2016;40(8):1200.

Kim SH, Lee WY, Yong SJ, Lee MK, Jung YR. Low selenium concentrations are associated with systemic inflammatory responses and prognostic markers in critically ill patients with respiratory diseases. American Journal of Respiratory and Critical Care Medicine 2015;191:A1603.

Mertens K, Lowes D, Webster N, et al. Low zinc and selenium concentrations in sepsis are associated with oxidative damage and inflammation. Br J Anaesth 2015;114(6):990-9.

Ruocco MAC, Cechinatti EDP, Barbosa F, Navarro AM. Zinc and selenium status in critically ill patients according to severity stratification. Nutrition 2018;45:85-9.

Manzanares W, Dhaliwal R, Jiang X, Murch L, Heyland DK. Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis. Crit Care 2012;16(2):R66.

Landucci F, Mancinelli P, De Gaudio AR, Virgili G. Selenium supplementation in critically ill patients: a systematic review and meta-analysis. J Crit Care 2014;29(1):150-6.

Alhazzani W, Jacobi J, Sindi A, et al. The effect of selenium therapy on mortality in patients with sepsis syndrome: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med 2013;41(6):1555-64.

Gusmao-Flores D, Salluh JIF, Chalhub RÁ, Quarantini LC. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care 2012;16(4):R115.

Tomasi CD, Grandi C, Salluh J, et al. Comparison of CAM-ICU and ICDSC for the detection of delirium in critically ill patients focusing on relevant clinical outcomes. J Crit Care 2012;27(2):212-7.

Mishra V, Baines M, Perry SE, et al. Effect of selenium supplementation on biochemical markers and outcome in critically ill patients. Clinical Nutrition. 2007;26(1):41-50.

Alehagen U, Lindahl TL, Aaseth J, Svensson E, Johansson P. Levels of sP-selectin and hs-CRP Decrease with Dietary Intervention with selenium and coenzyme Q10 Combined: a secondary analysis of a randomized clinical trial. PloS one 2015;10(9):e0137680.

Kim SH, Johnson VJ, Shin T-Y, Sharma RP. Selenium attenuates lipopolysaccharide-induced oxidative stress responses through modulation of p38 MAPK and NF-κB signaling pathways. Exp Biol Med (Maywood) 2004;229(2):203-13.

Valenta J, Brodska H, Drabek T, Hendl J, Kazda A. High-dose selenium substitution in sepsis: a prospective randomized clinical trial. Intensive Care Med 2011;37(5):808-15.

Zhang Z, Pan L, Deng H, Ni H, Xu X. Prediction of delirium in critically ill patients with elevated C-reactive protein. J Crit Care 2014;29(1):88-92.

Macdonald A, Adamis D, Treloar A, Martin F. C-reactive protein levels predict the incidence of delirium and recovery from it. Age Ageing 2006;36(2):222-5.

McGrane S, Girard TD, Thompson JL, et al. Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients. Crit Care 2011;15(2):R78.

How to Cite
Alikiaii B, Mousavi S, Hashemi ST, Abdollahi M. Effect of Selenium Supplementation on CRP Levels and Incidence of Delirium in Critically Ill Patients. J Pharm Care. 5(1-2):11-5.
Original Article(s)