Unanswered questions on the use of hydrocortisone, ascorbic acid, and thiamine therapy in sepsis and septic shock

Abstract

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To evaluate current evidence on the utility of hydrocortisone, ascorbic acid and thiamine (HAT) therapy for the management of septic shock. Summary The following keyword search terms were utilized in PubMed to identify relevant articles: ascorbic acid, thiamine, hydrocortisone, shock, and critical care. Articles relevant to HAT therapy in patients with septic shock were selected. Retrospective cohorts and randomized controlled trials were included in this review; case reports/series were excluded. Data from included studies illustrating the use of HAT therapy for the management of sepsis and septic shock, including data on time to HAT therapy initiation, severity of illness at baseline, duration of vasopressor therapy, progression of organ failure, and mortality, were evaluated. Conclusion The utilization of HAT therapy for the management of sepsis and septic shock remains controversial. Hemodynamic benefits have been shown to be most pronounced when HAT therapy is initiated earlier. Future studies directed at earlier initiation may be necessary to confirm this theory.

The Effect of Hydrocortisone-Ascorbic Acid and Thiamine Therapy on the Outcome of Patients with Sepsis: Prospective Randomized Double-Blinded Controlled Trial

“…Also, Ragoonanan et a. [25] documented that the hemodynamic benefit was most pronounced when ascorbic acid, hydrocortisone , thiamine therapy was initiated early in the disease course. Moreover, Song et al [32] reported that reduction in usage of vasopressor agents with the combination therapy in treating sepsis.…”

“…The usage of ascorbic acid, hydrocortisone, and thiamine therapy in septic shock and sepsis was also studied by Ragoonanan et al [25] in a metaanalyses, however they discovered no indication that mortality was improved.…”

Effect of Dietary Supplements with ω-3 Fatty Acids, Ascorbic Acid, and Polyphenolic Antioxidant Flavonoid on Gene Expression, Organ Failure, and Mortality in Endotoxemia-Induced Septic Rats

“…A diet containing ascorbic acid combined with hydrocortisone and thiamine improves sepsis features and consequences [ 79 ]. The utilization of combined hydrocortisone, ascorbic acid, and thiamine therapy appears to be safe and provides potential benefits for the management of sepsis and septic shock, but some aspects remain controversial since their actions seem to be modest in decreasing mortality [ 80 , 81 , 82 ]. The consumption of polyphenolic antioxidant flavonoids regulates gene expression.…”

Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Sepsis Associated with Acute Necrotizing Soft Tissue Infections: The NASTI-HAT Case Series

“…A multicenter approach would likely be most beneficial. Additionally, the timing of intravenous HAT administration may play a role in outcomes, with some suggesting earlier administration may be beneficial [27,28]. Therefore, future studies may want a much shorter window to administration than used in our study and may want to monitor this aspect of treatment more closely.…”