The Effect of Using Vitamin C, Hydrocortisone, and Thiamine Triple Therapy in the Treatment of Septic Shock

Abstract

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.

Intravenous corticosteroid treatment in adult patients with sepsis defined by the Sepsis-3 criteria: a systematic review and meta-analysis

“…Of the 24 included trials, 1 trial enrolled participants based on the Sepsis-3 criteria 49 ; and 9 trials 2 5 8-10 34 37 38 40 directly reported the patients’ baseline SOFA scores. We indirectly estimated the baseline SOFA scores for the other 14 studies 3 6 7 35 36 39 41-48 based on the reported biochemical laboratory data or the inclusion criteria of these trials. Notably, 2 RCTs 45 48 were evaluated only by the abstracts due to the inaccessibility of the main texts.…”

“…We indirectly estimated the baseline SOFA scores for the other 14 studies 3 6 7 35 36 39 41-48 based on the reported biochemical laboratory data or the inclusion criteria of these trials. Notably, 2 RCTs 45 48 were evaluated only by the abstracts due to the inaccessibility of the main texts. For the treatment group, hydrocortisone, 3 6 8-10 34 36-41 43 45-47 methylprednisolone, 35 44 hydrocortisone plus fludrocortisone, 2 7 and dexamethasone 5 were used in 16, 2, 2, and 1 trials, respectively.…”

“…For the treatment group, hydrocortisone, 3 6 8-10 34 36-41 43 45-47 methylprednisolone, 35 44 hydrocortisone plus fludrocortisone, 2 7 and dexamethasone 5 were used in 16, 2, 2, and 1 trials, respectively. Two other studies used the combination of hydrocortisone, Vitamin C, and thiamine, 48 49 and the other trial administered either dexamethasone or methylprednisolone to the participants in the treatment group. 42 For the control group, 20 RCTs 2 3 5-10 34-40 42 43 45-47 compared corticosteroid use with placebo, whereas 4 studies 41 44 48 49 provided standard of care for the patients in the control group.…”

“…Two other studies used the combination of hydrocortisone, Vitamin C, and thiamine, 48 49 and the other trial administered either dexamethasone or methylprednisolone to the participants in the treatment group. 42 For the control group, 20 RCTs 2 3 5-10 34-40 42 43 45-47 compared corticosteroid use with placebo, whereas 4 studies 41 44 48 49 provided standard of care for the patients in the control group.…”

The Effects of Ascorbic Acid Over Sepsis: Meta-analysis With Trial Sequential Analysis

“…After reviewing the full texts, 12 records [18][19][20][21][22][23][24][25][26][27][28][29][30] met the inclusion criteria and were nally included ( Table 1). Studies were excluded for the following reasons: duplication (n = 24), non-RCTs (n = 1) [37] .…”