Abstract
Background: Intravenous vitamin C and thiamine administration may be a potential adjuvant therapy for septic shock. We aimed to investigate the impact of early vitamin C and thiamine administration in septic shock patients. Methods: This retrospective before-and-after cohort study used data extracted from the Korean Shock Society’s prospective septic shock registry. We compared 28-day and in-hospital mortality rates between patients treated with intravenous vitamin C (3 g/12 h or 1.5 g/6 h) and thiamine (200 mg/12 h) <6 h after shock recognition from July through December 2017 (n = 229) and control patients from October 2015 through June 2017 (n = 915) using propensity score matching. Results: The 28-day (18.3% vs. 17.5%; p = 0.76) and in-hospital (16.6% vs. 18.3%; p = 0.55) mortality rates did not differ between treatment and control groups, nor did 28-day (18.5% vs. 17.5%; p = 0.84) and in-hospital (16.7% vs. 18.4%; p = 0.54) mortality rates after matching. In the subgroup analysis, treatment was associated with lower in-hospital mortality rates in patients with albumin <3.0 mg/dL or a Sequential Organ Failure Assessment (SOFA) score >10. Conclusion: Early vitamin C and thiamine administration in patients with septic shock did not improve survival; however, administration could benefit conditions that are more severe, such as hypoalbuminemia or severe organ failure.
Highlights
Sepsis is a complex disease involving life-threatening organ dysfunction caused by a dysregulated host response to infection that remains associated with unacceptably high mortality rates [1]
Evidence is emerging that the parenteral administration of vitamin C may be a potential adjuvant therapy, the clinical effect on patients with septic shock and the optimal administration protocol remain to be determined. In this retrospective before-and-after study, we evaluated the efficacy of early vitamin C and thiamine administration for patients with septic shock who were treated with protocol-driven resuscitation bundle therapy in emergency departments (EDs)
229 patients who received vitamin and thiamine infusions during their initial resuscitations were assigned to the treatment group (85 from hospital A, 144 from hospital B), whereas the 915 patients who did not receive infusions comprised the control group
Summary
Sepsis is a complex disease involving life-threatening organ dysfunction caused by a dysregulated host response to infection that remains associated with unacceptably high mortality rates [1]. Septic shock should be considered a medical emergency, and focus must be placed on timely intervention, including the early identification and treatment of infection through appropriate antimicrobial therapy and source control when applicable, as well as the reversal of hemodynamic instability through fluid resuscitation and vasopressor use, if necessary [2] Despite these supportive therapies, morbidity and mortality rates remain high, suggesting the need for adjuvant therapies for inflammatory and oxidative stress in patients with septic shock. Considering acute consumption in the hypermetabolic state, thiamine supplementation might be a reasonable therapeutic adjunct for patients with sepsis, and has been added to reduce the risk of renal oxalate crystallization [12] These findings led to a recent before-and-after study showing that sepsis treatment consisting of a combination of vitamin C, hydrocortisone, and thiamine prevented organ dysfunction and reduced mortality rates [6]. Conclusion: Early vitamin C and thiamine administration in patients with septic shock did not improve survival; administration could benefit conditions that are more severe, such as hypoalbuminemia or severe organ failure
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