Abstract
Triple therapy with steroids, vitamin C and thiamine has been recently proposed as a safe and beneficial in patients with sepsis. In 2017, we added the use of intravenous vitamin C and thiamine in septic shock patients receiving low dose hydrocortisone because poorly responsive to vasopressors. Aim of this study is to verify whether triple therapy rather than steroids alone can improve outcome in patients with refractory shock. In this before-after retrospective analysis, we compared septic shock patients admitted to our intensive care unit (ICU) who received triple therapy from June 2017 to November 2019 to septic shock patients who received only hydrocortisone from January 2015 to June 2017. Patients of the two study periods were matched 1:1 using a propensity score model. A final cohort of 56 patients treated with triple therapy were matched to 56 patients treated only with steroids. Triple therapy reduced the length of mechanical ventilation (p=0,01) and showed a trend in lowering the 30-day and hospital mortality compared to therapy with only hydrocortisone. Although with significant limitations, our experience indicated that triple therapy seems to provide an improvement of clinical outcomes in patients with refractory septic shock.
Highlights
Based on their pleiotropic effects at cellular and mitochondrial level, intravenous administration of vitamin C and thiamine, combined with steroids, has been recently promoted as a potential adjunctive therapy in patients with septic shock [1,2]
Study population and treatment protocol. In this before-after case-control study we included consecutive adult patients admitted to the polyvalent intensive care unit (ICU) of the Modena University Hospital with septic shock and receiving low-dose steroids from January 2015 to November 2019
153 patients with septic shock were treated with hydrocortisone because of high dosages of noradrenaline, 60 of which received with vitamin C and thiamine
Summary
Based on their pleiotropic effects at cellular and mitochondrial level, intravenous administration of vitamin C and thiamine, combined with steroids, has been recently promoted as a potential adjunctive therapy in patients with septic shock [1,2]. Vitamin C is an important co-factor for the synthesis of endogenous adrenaline and exerts multifaceted antioxidant activities with a pivotal role in modulating inflammation [1,2,3]. Thiamine is a key co-factor in oxidative glucose metabolism for energy production and synthesis of glucose-derived neurotransmitters [7,8]. As vitamin C, thiamine body reserves are seriously reduced in critically ill patients and, thereby, its supplementation might be reasonable, in the hypermetabolic states. Thiamine modifies the metabolism of vitamin C reducing the production of oxalate, thereby
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