Thiamine as a metabolic resuscitator in septic shock: one size does not fit all

Costa, Nara Aline; Azevedo, Paula S.; Polegato, Bertha Furlan; Zornoff, Leonardo A. M.; Paiva, Sérgio Alberto Rupp de; Minicucci, Marcos F.

doi:10.21037/jtd.2016.04.29

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…Thiamine has proved to be appealing adjunctive therapy and a metabolic resuscitator for patients with septic shock [14,15]. Thiamine levels are depleted during critical illness, which contributes to mitochondrial metabolic impairments and causes lactic acidosis; replenishing thiamine during critical illness might improve organ dysfunction through increased lactate clearance [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of vitamin C, thiamine, and corticosteroid therapy in adult sepsis patients: a systematic review and meta-analysis

et al. 2021

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Background: Previous studies have suggested favorable outcomes of hydrocortisone, ascorbic acid (vitamin C), and thiamine (HAT) therapy in patients with sepsis. However, similar results have not been duplicated in sequential studies. This meta-analysis aimed to reevaluate the value of HAT treatment in patients with sepsis. Methods: Electronic databases were searched up until October 2020 for any studies that compared the effect of HAT versus non-HAT use in patients with sepsis. Results: Data from 15 studies (eight randomized controlled trials [RCTs] and seven cohort studies) involving 67,349 patients were included. The results from the RCTs show no significant benefit of triple therapy on hospital mortality (risk ratio [RR], 0.99; P = 0.92; I 2 = 0%); intensive care unit (ICU) mortality (RR, 0.77; P = 0.20; I 2 = 58%); ICU length of stay (weighted mean difference [WMD], 0.11; P=0.86; I 2 =37%) or hospital length of stay (WMD: 0.57; P=0.49; I 2 =17%), and renal replacement therapy (RR, 0.64; P = 0.44; I 2 = 39%). The delta Sequential Organ Failure Assessment (SOFA) score favored treatment after a sensitivity analysis (WMD, -0.72; P=0.01; I 2 = 32%). However, a significant effect was noted for the duration of vasopressor use (WMD, -25.49; P < 0.001; I 2 = 46%). The results from cohort studies have also shown no significant benefit of HAT therapy on hospital mortality, ICU mortality, ICU length of stay, length of hospital stay, the delta SOFA score, the use of renal replacement therapy, or vasopressor duration. Conclusions: HAT therapy significantly reduced the duration of vasopressor use and improved the SOFA score but appeared not to have significant benefits in other outcomes for patients with sepsis. Further RCTs can help understand its benefit exclusively.

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Section: Introductionmentioning

confidence: 99%

The Efficacy of vitamin C, thiamine, and corticosteroid therapy in adult sepsis patients: a systematic review and meta-analysis

et al. 2021

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“…As thiamine deficiency appears to be relatively common in critical illness, and has been previously associated with lactic acidosis and hypotension, thiamine supplementation has emerged as an attractive pharmacologic means of enhancing mitochondrial function in sepsis (19,20). To date, however, the effect of thiamine supplementation on the prevention or treatment of sepsis-related AKI has not been studied.…”

Section: Discussionmentioning

confidence: 99%

Thiamine as a Renal Protective Agent in Septic Shock. A Secondary Analysis of a Randomized, Double-Blind, Placebo-controlled Trial

et al. 2017

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“…Wet beriberi presents as congestive high‐output heart failure . The exact mechanisms by which thiamin deficiency leads to heart failure are not yet completely understood, but it is believed that the energy deficit in the myocardium that is due to the decreased enzyme activity may play an important role . In addition, thiamin deficiency causes peripheral vasodilation, decreased organ perfusion, and subsequent retention of sodium and water, which may generate a hypervolemic state and a consequent increase in peripheral venous pressure and edema …”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…Thiamin replacement in other patient groups, such as in critically ill patients with an absence of diagnosed deficiency, is still controversial. Although some authors recommend prophylactic supplementation in these situations, scientific evidence for this practice has not been established …”

Section: Treatmentmentioning

confidence: 99%

Role of Thiamin in Health and Disease

et al. 2019

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Thiamin is a hydrosoluble vitamin that plays a role in several biological processes, mainly in glucose metabolism. There are several risk factors for developing thiamin deficiency, such as malnutrition, refeeding syndrome, gastrointestinal surgery, and alcoholism. Recently, the role of thiamin in critically ill patients has gained prominence, and the prevalence of thiamin deficiency was found to be increased in patients with severe burns, major surgery, septic shock, end-stage renal disease, and heart failure. In adults, thiamin deficiency presents as encephalopathy, dry beriberi (with neurological signs and symptoms), or wet beriberi (with cardiovascular signs and symptoms). Thiamin deficiency can be diagnosed clinically, and all clinicians should be aware of this disease, especially in patients with risk factors for thiamin deficiency. Thiamin supplementation should be started as early as possible in patients suspected to have thiamin deficiency. Treatment is safe, inexpensive, simple, and life-saving. Diagnosis is confirmed on a positive response to treatment. (Nutr Clin Pract. 2019;34:558-564)

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Thiamine as a metabolic resuscitator in septic shock: one size does not fit all

Cited by 9 publications

References 10 publications

The Efficacy of vitamin C, thiamine, and corticosteroid therapy in adult sepsis patients: a systematic review and meta-analysis

The Efficacy of vitamin C, thiamine, and corticosteroid therapy in adult sepsis patients: a systematic review and meta-analysis

Thiamine as a Renal Protective Agent in Septic Shock. A Secondary Analysis of a Randomized, Double-Blind, Placebo-controlled Trial

Role of Thiamin in Health and Disease

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