Comparison of Hydrocortisone with Combined Hydrocortisone, Ascorbic Acid, and Thiamine as an Adjuvant Therapy on Septic Shock Patients on Mortality: A Systematic Review and Meta-analysis

Abstract

BACKGROUND: Septic shock is still considered a global health problem because it is the main cause of morbidity and mortality in critical patients. Various clinical studies have proven that intravenous administration of high dose ascorbic acid and corticosteroid helps slow the inflammation cascade. These studies help lower the global sepsis and septic shock burden with cost-effective methods and minimum side effects. We systematically reviewed the comparison between hydrocortisone and hydrocortisone-ascorbic acid-thiamine (HAT) combined therapy as an adjuvant in the mortality rate of septic shock patients. METHODS: Four databases (PubMed, EMBASE, Scopus, and Cochrane) are comprehensively searched using specific keywords up to October 18, 2021. All published studies on the use of HAT on septic shock patients were collected and reviewed. RESULTS: Three randomized controlled trials and two controlled trials enrolling 635 patients were included in the study. HAT therapy was found to be not significant in reducing the intensive care unit (ICU) mortality rate (respiratory rate [RR] 0.89 95% confidence interval [CI] [0.60–1.32], p = 0.56), hospital mortality rate (RR 1.2 95% CI [0.90–1.59], p = 0.21), and 28 days mortality (RR 0.95, 95% CI [0.56–1.58], p = 0.83). CONCLUSION: HAT is ineffective in reducing ICU, hospital, and 28-days mortality in septic shock patients when compared with hydrocortisone therapy, although HAT adjuvant therapy significantly reduces ICU length of stay, ventilator usage duration, and vasopressor usage duration.