Impact of Vitamin C and Thiamine Administration on Delirium-Free Days in Patients with Septic Shock.

Sung Yeon Hwang,Jong Eun Park,Gee Young Suh,Minsu Park,Ik Joon Jo,Kyeongman Jeon,Tae Gun Shin,Hojeong Won,Chi Ryang Chung

doi:10.3390/jcm9010193

Sung Yeon Hwang, Jong Eun Park + Show 7 more

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https://doi.org/10.3390/jcm9010193

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Abstract

Sepsis is a common cause of delirium in the intensive care unit (ICU). Recently, vitamin C and thiamine administration has been gaining interest as a potential adjunct therapy for sepsis. We investigated the impact of early vitamin C and thiamine administration on ICU delirium-free days among critically ill patients in septic shock. We performed a single-center, retrospective study of patients who visited the emergency department (ED) from January 2017 to July 2018. We categorized patients into a treatment (received vitamin C and thiamine) and control group. We compared delirium-free days within 14 days after ICU admission using propensity score matching. Of 435 patients with septic shock, we assigned 89 propensity score-matched pairs to the treatment and control groups. The median delirium-free days did not differ between treatment (11, interquartile range [IQR] 5–14 days) and control (12, IQR 6–14 days) groups (p = 0.894). Secondary outcomes were not different between the two groups, including delirium incidence and 28-day mortality. These findings were consistent after subgroup analysis for patients who met the sepsis-3 definition of septic shock. Vitamin C and thiamine administration showed no association with ICU delirium-free days among patients in septic shock.

Highlights

Delirium is an acute brain dysfunction that is characterized by a disturbance in attention and awareness, cognitive impairment, and psychomotor behavioral disturbances that develop over a short period and fluctuates during the day [1]
The objective of this study was to evaluate the impact of early combination therapy with vitamin C and thiamine on intensive care unit (ICU) delirium-free days in patients with septic shock who were admitted via the emergency department (ED)
Our results showed that vitamin C and thiamine administration was not associated with increased delirium-free days in septic shock patients who presented at the ED

Summary

Introduction

Delirium is an acute brain dysfunction that is characterized by a disturbance in attention and awareness, cognitive impairment, and psychomotor behavioral disturbances that develop over a short period and fluctuates during the day [1]. Efforts to properly manage delirium are important to prevent and decrease its negative consequences. Both vitamin C and thiamine deficiencies are common in septic patients [6,7]. Vitamin C plays important roles, including the scavenging of free radicals, improvement of the endothelial and blood–brain barrier functions, and the modulation of neurotransmitters, which are all involved in the pathophysiology of delirium [10,11]. Thiamine deficiency can lead to decreased production of adenosine triphosphate (ATP), since it plays a role as a cofactor in the Kreb’s cycle. Decrease in glutathione leads to an impairment in the scavenging of free radicals that causes cellular injuries in the neuronal cells, further contributing to the development of delirium [9]

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