Heavy Metal in the Intensive Care Unit

Bang

et al. 2018

Biol Trace Elem Res

We measured serum concentrations of trace elements and evaluated their clinical significance in relation to treatment outcomes of critically ill patients. A total of 167 participants (105 men and 62 women; average age, 61.4 years; age range, 18-90 years) were enrolled. Arterial blood concentrations of the trace elements zinc, copper, selenium, and manganese were measured every 14 days. At the time of intensive care unit (ICU) admission, serum concentrations of zinc, selenium, copper, and manganese were lower than the normal values in 75.1, 1.8, 37.8, and 2.1% of patients, respectively. Serum trace element concentrations measured on day 14 of ICU stay were higher than those measured at the time of ICU admission for zinc (53.3 → 80.7 μg/L) and copper (87.1 → 102.3 μg/L). Increased serum zinc and copper concentrations during ICU care were associated with a significantly lower mortality compared to decreased concentrations of zinc (15.6 vs. 83.3%, p = 0.003) and copper (5.6 vs. 50.0%, p = 0.013). At the time of ICU admission, low serum levels of zinc and copper were observed. Patients with increased serum concentrations of zinc and copper had significantly lower mortality.

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Serum Concentrations of Trace Elements Zinc, Copper, Selenium, and Manganese in Critically Ill Patients

Bang

et al. 2018

Biol Trace Elem Res

“…On the one hand, Cu or Zn deficiencies impair the immune defense and confer a high susceptibility to infectious diseases [3,4,5,6,8]. On the other hand, acute infections cause an increase in serum Cu in the context of an acute phase response [4,9] and a decrease in serum Zn due to a redistribution into liver and other tissues [3,7,10,11,12]. These two responses to inflammation may feed a vicious cycle of impaired immune defense and higher infection risk, which is of particular importance especially in very vulnerable patients, such as preterm and term neonates with an immature immune system.…”

Section: Introductionmentioning

confidence: 99%

Copper to Zinc Ratio as Disease Biomarker in Neonates with Early-Onset Congenital Infections

et al. 2017

Copper (Cu) and zinc (Zn) are essential trace elements for regular development. Acute infections alter their metabolism, while deficiencies increase infection risks. A prospective observational case-control study was conducted with infected (n = 21) and control (n = 23) term and preterm newborns. We analyzed trace element concentrations by X-ray fluorescence, and ceruloplasmin (CP) by Western blot. Median concentration of Cu at birth (day 1) was 522.8 [387.1–679.7] μg/L, and Zn was 1642.4 ± 438.1 μg/L. Cu and Zn correlated positively with gestational age in control newborns. Cu increased in infected newborns from day 1 to day 3. CP correlated positively to Cu levels at birth in both groups and on day 3 in the group of infected neonates. The Cu/Zn ratio was relatively high in infected newborns. Interleukin (IL)-6 concentrations on day 1 were unrelated to Cu, Zn, or the Cu/Zn ratio, whereas C-reactive protein (CRP) levels on day 3 correlated positively to the Cu/Zn -ratio at both day 1 and day 3. We conclude that infections affect the trace element homeostasis in newborns: serum Zn is reduced, while Cu and CP are increased. The Cu/Zn ratio combines both alterations, independent of gestational age. It may, thus, constitute a meaningful diagnostic biomarker for early-onset infections.

“…12 Critical conditions such as burns, trauma and septic shock are often associated with severe inflammation and oxidative stress, immune dysfunction and malnutrition, and metabolic requirements for vitamins and trace elements, in particular for selenium and zinc, may be increased. 13, 14, 15, 16, 17 Whether single or multiple organ failure (for example, of the liver or kidney) leads to higher or even lower trace element requirements remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Parenteral trace element provision: recent clinical research and practical conclusions

2016

The aim of this systematic review (PubMed, www.ncbi.nlm.nih.gov/pubmed and Cochrane, www.cochrane.org; last entry 31 December 2014) was to present data from recent clinical studies investigating parenteral trace element provision in adult patients and to draw conclusions for clinical practice. Important physiological functions in human metabolism are known for nine trace elements: selenium, zinc, copper, manganese, chromium, iron, molybdenum, iodine and fluoride. Lack of, or an insufficient supply of, these trace elements in nutrition therapy over a prolonged period is associated with trace element deprivation, which may lead to a deterioration of existing clinical symptoms and/or the development of characteristic malnutrition syndromes. Therefore, all parenteral nutrition prescriptions should include a daily dose of trace elements. To avoid trace element deprivation or imbalances, physiological doses are recommended.