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Sodium selenite, procalcitonin-guided therapy do not improve mortality in sepsis

High-doses of sodium selenite and anti-infectious therapy guided by a procalcitonin algorithm do not improve the outcome in patients with severe sepsis, according to data from a recent study.

“Evidence to support procalcitonin-guided anti-infectious therapy is contradictive,” Frank Bloos, MD, PhD, and colleagues wrote. “The objective of the present trial was to assess the efficacy of high-dose IV sodium selenite treatment and of procalcitonin-guided anti-infectious therapy in patients with severe sepsis.”

The Placebo-Controlled Trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT) was a multicenter randomized, clinical trial conducted in 33 ICUs in Germany from November 6, 2009, to June 6, 2013. The follow-up period was 90 days.

The researchers randomly assigned patients an IV loading dose of sodium selenite (1000 g), followed by continuous IV infusion of sodium selenite daily until discharge, but no longer that 21 days, or placebo. Patients also randomly received anti-infectious therapy guided by a procalcitonin algorithm or without procalcitonin guidance.

Out of 8,174 patients, 1,089 (13.3%) with severe sepsis or septic shock were included in an intention-to-treat analysis comparing sodium selenite (49.9%) with placebo (50.1%) and procalcitonin guidance (50.7%) compared to those without (49.3%). The 28-day mortality rate was 28.3% (95% CI, 24.5-32.3) in the sodium selenite group compared with 25.5% (95% CI, 21.8-29.4) (P = .3) in the placebo group. The researchers also found procalcitonin guidance did not affect frequency of diagnostic or therapeutic procedures. Procalcitonin guidance resulted in a 4.5% reduction of antimicrobial exposure; however, no significant difference was found in 28-day mortality between patients assigned to procalcitonin guidance and those without.

“These findings do not support administration of high-dose sodium selenite in critically ill patients,” Bloos and colleagues wrote. “This trial demonstrates that neither high-dose IV administration of sodium selenite nor procalcitonin-guided antimicrobial therapy was associated with improved 28-day mortality in patients with severe sepsis.”– by Savannah Demko

Disclosure: The researchers report no relevant financial disclosures.