(440) Incidence of Selenium Deficiency in Patients With Significant Burn Injuries

Introduction: Selenium (Se) is an essential micronutrient that aids in immune response and wound healing. Deficiency may lead to viral infections, decreased immune function, cognitive impairment, and cardiomyopathies. Previous studies suggest patients with burns are prone to Se deficiency due to increased losses in exudate and urine, and low intake from enteral nutrition (EN) with low Se content. Much data is older and may not reflect current burn management strategies and EN formulas. Monitoring Se is challenging as critically ill patients often have significant inflammation which decreases plasma Se concentrations. The European Society for Clinical Nutrition and Metabolism suggests simultaneous measurement of Se and C-reactive protein (CRP) and provides specific guidance on Se interpretation based on degree of inflammation. The American Society for Parenteral and Enteral Nutrition makes no Se recommendations for patients with burns. Our institution generally obtains Se concentrations in patients with large burns (>20% total body surface area, TBSA) and does not empirically supplement Se. Our aim was to determine the incidence of Se deficiency in patients with burns and identify populations at highest risk of deficiency to guide Se monitoring strategies.

Methods: This retrospective review evaluated adults (> 18 yo) admitted to Vanderbilt University Medical Center burn unit from 6/1/23 to 5/31/24 with at least one Se level. The primary outcome was incidence of low Se concentrations. Patient demographics, nutrition route (enteral (EN), parenteral (PN), oral), TBSA burned, and length of stay (LOS) were also collected. Descriptive statistics were performed.

Results: Forty-one patients were included: 68% were male, median age was 45 years, 26% TBSA burn, and LOS was 40.7 days. EN was utilized in 58.5%, 34.1% had oral diets, and 7.3% received PN. The first Se level was collected 4.7 (3.0-14.1) days after admission and was below normal range ( < 63 mcg/L) in 14 patients (34%). Once corrected for elevated CRP, 0 Se levels were below normal range. No follow-up corrected Se concentrations were low.

Conclusions: Selenium deficiency was not noted in any patient with burns, once corrected for inflammation. This suggests patients with significant burns may not require routine Se monitoring or supplementation.