Objective: The trace elements selenium, copper, and zinc are essential for maintaining the oxidative balance. A depletion of antioxidative trace elements has been observed in critically ill patients and is associated with the development of multiorgan dysfunction and an increased mortality. Cardiac surgery using cardiopulmonary bypass provokes ischemia-reperfusion-mediated oxidative stress. We hypothesized that an intraoperative decrease of circulating trace elements may be involved in this response.
Design: Prospective observational clinical study.
Setting: University hospital cardiothoracic operation theater and intensive care unit.
Patients: Sixty patients (age 65 ± 14 yrs) undergoing cardiac surgery with the use of cardiopulmonary bypass.
Measurements and Main Results: Whole blood concentrations of selenium, copper, and zinc were measured after induction of anesthesia and 1 hr after admission to the intensive care unit. All patients were separated in a priori defined subgroups according to the development of no organ failure, single organ failure, and ≥2 organ failures in the postoperative period.
Results: Fifty patients exhibited a significant selenium deficiency already before surgery, whereas copper and zinc concentrations were within the reference range.
In all patients, blood levels of selenium, copper, and zinc were significantly reduced after end of surgery when compared to preoperative values (selenium: 89.05 ± 12.65 to 70.84 ± 10.46 μg/L; zinc: 5.15 ± 0.68 to 4.19 ± 0.73 mg/L; copper: 0.86 ± 0.15 to 0.65 ± 0.14 mg/L; p < .001).
During their intensive care unit stay, 17 patients were free from any organ failure, while 31 patients developed single-organ failure and 12 patients multiple organ failure.
Multilogistic regression analysis showed that selenium concentrations at end of surgery were independently associated with the postoperative occurrence of multiorgan failure (p = .0026, odds ratio 0.8479, 95% confidence interval 0.7617 to 0.9440).
Conclusions: Cardiac surgery using cardiopulmonary bypass resulted in a profound intraoperative decrease of whole blood levels of antioxidant trace elements. Low selenium concentrations at end of surgery were an independent predictor for the postoperative development of multiorgan failure.
From the Departments of Anaesthesiology (CS, GS, RR, MC, BG, SR), Intensive Care (CS, GM, SR), and Thoracic, Cardiac and Vascular Surgery (JS), University Hospital, RWTH Aachen, Germany.
Presented, in part, at the 22nd annual congress of the European Society of Intensive Care Medicine, Vienna, Austria, October 11th–14th, 2009: Intraoperative decreases of selenium, zinc and copper are associated with the development of severe systemic inflammatory response syndrome immediately after open-heart surgery.
Dr. Rex has received speaking fees from Biosyn Arzneimittel GmbH, Fellbach, Germany. The Department of Anesthesiology has received a research grant from Biosyn, Arzneimittel GmbH, Fellbach, Germany. The remaining authors have not disclosed any potential conflicts of interest.
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