THE EFFECT OF USING VITAMIN C, HYDROCORTISONE, AND THIAMINE TRIPLE THERAPY IN THE TREATMENT OF SEPTIC SHOCK

Abstract

SESSION TITLE: Sepsis: New Insights in Taming the Beast SESSION TYPE: Original Investigations PRESENTED ON: 10/23/2019 10:45 AM - 11:45 AM PURPOSE: Sepsis is a clinical syndrome with physiologic and biochemical derangements caused by dysregulated inflammatory response to an infection. A recent retrospective study showed that vitamin C, hydrocortisone and thiamine in intensive care unit (ICU) patients with septic shock when added to standard care improved mortality and outcomes. We undertook a prospective single-blinded study to evaluate effects of addition of this triple therapy to standard ICU care on 28-day mortality in patients with septic shock. METHODS: Patients at LAC+USC Medical Center with septic shock defined as sepsis-induced hypotension requiring vasopressors with serum lactate level >2 mmol/L were enrolled within 24 hours of identification. Exclusion criteria included inability to obtain consent, incarceration, active malignancy, dementia, pregnancy or lactation, active ischemic or hemorrhagic stroke, active cardiogenic or other causes of shock, history of renal stones and current use of steroids. Patients were blinded as to treatment group and randomized by a blinded operator in block randomization in a 1:1 fashion in groups of 8. Patients received either standard ICU care (control) or standard care plus intravenous (IV) Vitamin C 1.5 gram every 6 hours for 4 days or until ICU discharge, IV hydrocortisone 50 mg every 6 hours for 7 days or until ICU discharge, and IV thiamine 200 mg every 12 hours for 4 days or until ICU discharge. Data were analyzed using SPSS with a chi squared test. P-value <0.05 was considered statistically significant. RESULTS: Analysis of 18 patients enrolled to date with 9 per group showed no significant difference at baseline between the two groups in terms of demographics or septic shock severity. There was a 50% mortality in the control group with no deaths in the triple therapy group. Statistically significant improvements were seen in vasoactive drug requirements, need for continuous renal replacement or hemodialysis, hours to lactate clearance, and ICU length of stay in the treatment arm. No adverse drug effects were seen in the triple therapy group. CONCLUSIONS: Despite the small number of patients analyzed to date, this prospective analysis shows a favorable response to triple therapy, with statistically and clinically significant reductions in ICU length of stay and mortality. Furthermore, triple therapy had a low side-effect profile, indicating safety for use. This prospective human study so far confirms results of a previous retrospective study and suggest that triple therapy may modulate the inflammatory response in sepsis, allowing more rapid resolution of shock, although exact mechanisms remain to be determined. CLINICAL IMPLICATIONS: The combination of vitamin C, hydrocortisone, and thiamine in addition to standard ICU care may improve mortality and outcomes in patients with septic shock. These findings are currently being validated in an expanded cohort through ongoing enrollment at our center. DISCLOSURES: No relevant relationships by Patrick Baghdasaryan, source=Web Response No relevant relationships by Ahmet Baydur, source=Admin input No relevant relationships by Kelly Fan, source=Web Response No relevant relationships by May Lee, source=Web Response No relevant relationships by Jordan Rees, source=Web Response No relevant relationships by Reza Ronaghi, source=Web Response No relevant relationships by Jennifer Tang, source=Web Response