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In patients with sepsis and septic shock, selenium deficiency is linked to elevated pro-inflammatory cytokines like TNF-α, IL-1β, and IL-6, exacerbating systemic inflammation and worsening outcomes [5,49,74]

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The diagnosis of vitamin B12 deficiency typically relies on low total B12 levels and elevated concentrations of homocysteine (Hcy), as well as levels of transcobalamin-bound B12 (holoTC) and methylmalonic acid (MMA), which serve as functional indicators of cobalamin insufficiency (Carmel and Sarrai, 2006)