Early Selenium Treatment for Traumatic Brain Injury: Does it Improve Survival and Functional Outcome?

Publication date: Available online 8 July 2017
Source:Injury
Author(s): Hosseinali Khalili, Rebecka Ahl, Cao Yang, Shahram Paydar, Gabriel Sjölin, Amin Niakan, Gholamreza Dabiri, Shahin Mohsenid
BackgroundTraumatic brain injury (TBI) is a major cause of death and debility following trauma. The initial brain tissue insult if worsened by secondary reactive responses including oxidative stress reactions, inflammatory changes and subsequent permanent neurologic deficits. Effective agents to improve functional outcome and survival following TBI are scarce. Selenium is an anti-oxidant which has shown to reduce oxidative stress. This study examines the effect of early intravenous selenium (Selenase^®) treatment in patients with severe TBI on functional outcome and survival in a prospective study design.MethodsPatients sustaining TBI were prospectively identified during a 12-month period at an academic urban trauma center. Study inclusion criteria applied were: age ≥18 years, blunt injury mechanism and admission to neurosurgical intensive care unit (NICU). Early deaths (≤48hours) and patients suffering extracranial injuries requiring invasive interventions or surgery were excluded. All consecutive admissions during a six-month period were administered intravenous Selenase^® for a maximum 10-day period and did constitute cases. Patient demographics and outcomes up to six-months post-discharge were collected for analysis.ResultsA total of 307 patients met inclusion criteria of which 125 were administered Selenase^®. Stepwise Poisson regression analysis identified five common predictors of poor functional outcome and in-hospital mortality: GCS ≤8, age ≥55 years, hypotension at admission, high Rotterdam score and invasive neurosurgical intervention. Selenase^® significantly reduced the risk of unfavourable functional outcome, defined as GOS-E ≤4, at both discharge (adjusted RR 0.69, 95% CI 0.51-0.92, p=0.012) and at six months follow-up (adjusted RR 0.61, 95% CI 0.44-0.83, p=0.002). Following adjustment for significant group differences similar results were seen for functional outcome. Selenase^® did not improve survival (adjusted RR 1.12, 95% CI 0.62-2.02, p=0.709).ConclusionEarly intravenous Selenase^® treatment demonstrates a significant improvement in functional neurologic outcome. This effect is sustained at six months following discharge.



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