SynthesisCritical care (London, England)2012
Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis.
Synthesis in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
68 citing papers in PubMed, 9 syntheses or guidelines pooled it, 231 citations in OpenAlex.
- The effect of selenium therapy in critically ill patients: an umbrella review of systematic reviews and meta-analysis of randomized controlled trials.European journal of medical research · 2023Pooled it
- Multivariate meta-analysis of critical care meta-analyses: a meta-epidemiological study.BMC medical research methodology · 2021Pooled it
- The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review.The Journal of nutrition · 2021Pooled it
- Impact of Nutrition on Telomere Health: Systematic Review of Observational Cohort Studies and Randomized Clinical Trials.Advances in nutrition (Bethesda, Md.) · 2020Pooled it
- Strategies to decrease oxidative stress biomarker levels in human medical conditions: A meta-analysis on 8-iso-prostaglandin FRedox biology · 2018Pooled it
- High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis.Critical care (London, England) · 2016Pooled it
- Parenteral trace element provision: recent clinical research and practical conclusions.European journal of clinical nutrition · 2016Pooled it
- Selenium supplementation for critically ill adults.The Cochrane database of systematic reviews · 2015Pooled it
- Effect of parenteral selenium supplementation in critically ill patients: a systematic review and meta-analysis.PloS one · 2013Pooled it
- Efficacy of Acetylcysteine and Selenium in Aneurysmal Subarachnoid Hemorrhage Patients: A Prospective, Multicenter, Single Blind Randomized Controlled Trial.Journal of Korean medical science · 2023Trial
- The effect of β-carotene on the mortality of male smokers is modified by smoking and by vitamins C and E: evidence against a uniform effect of nutrient.Journal of nutritional science · 2020Trial
- Trial
- Observational
- Review
- Therapeutic Uses of Retinol and Retinoid-Related Antioxidants.Molecules (Basel, Switzerland) · 2025Review
- Trace elements: Clinical perspectives in the critically ill.Journal of the Intensive Care Society · 2025Review
- Treatment effect of intravenous high-dose selenium in sepsis phenotypes: a retrospective analysis of a large multicenter randomized controlled trial.Journal of intensive care · 2025Article
- Oxidative Stress Markers and Prediction of Severity With a Machine Learning Approach in Hospitalized Patients With COVID-19 and Severe Lung Disease: Observational, Retrospective, Single-Center Feasibility Study.JMIR formative research · 2025Observational
- The anti-inflammatory and antioxidant effects of astaxanthin as an adjunctive therapy in community-acquired pneumonia: a randomized controlled trial.Frontiers in pharmacology · 2025Article
- Nutritional and metabolic modulation of inflammation in critically ill patients: a narrative review of rationale, evidence and grey areas.Annals of intensive care · 2024Review
8 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionCritical illness is characterized by oxidative stress, which is a major promoter of systemic inflammation and organ failure due to excessive free radical production, depletion of antioxidant defenses, or both. We hypothesized that exogenous supplementation of trace elements and vitamins could restore antioxidant status, improving clinical outcomes.
methodsWe searched computerized databases, reference lists of pertinent articles and personal files from 1980 to 2011. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated relevant clinical outcomes with antioxidant micronutrients (vitamins and trace elements) supplementation versus placebo.
resultsA total of 21 RCTs met inclusion criteria. When the results of these studies were statistically aggregated (n = 20), combined antioxidants were associated with a significant reduction in mortality (risk ratio (RR) = 0.82, 95% confidence interval (CI) 0.72 to 0.93, P = 0.002); a significant reduction in duration of mechanical ventilation (weighed mean difference in days = -0.67, 95% CI -1.22 to -0.13, P = 0.02); a trend towards a reduction in infections (RR= 0.88, 95% CI 0.76 to 1.02, P = 0.08); and no overall effect on ICU or hospital length of stay (LOS). Furthermore, antioxidants were associated with a significant reduction in overall mortality among patients with higher risk of death (>10% mortality in control group) (RR 0.79, 95% CI 0.68 to 0.92, P = 0.003) whereas there was no significant effect observed for trials of patients with a lower mortality in the control group (RR = 1.14, 95% 0.72 to 1.82, P = 0.57). Trials using more than 500 μg per day of selenium showed a trend towards a lower mortality (RR = 0.80, 95% CI 0.63 to 1.02, P = 0.07) whereas trials using doses lower than 500 μg had no effect on mortality (RR 0.94, 95% CI 0.67 to 1.33, P = 0.75).
conclusionsSupplementation with high dose trace elements and vitamins may improve outcomes of critically ill patients, particularly those at high risk of death.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.