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Hydrocortisone, Vitamin C, and Thiamine in Severe Sepsis and Septic Shock: Difference between revisions
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Hydrocortisone, Vitamin C, and Thiamine in Severe Sepsis and Septic Shock (view source)
Revision as of 03:13, 7 December 2017
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<ref>{{#pmid:8844239}}</ref> | <ref>{{#pmid:8844239}}</ref> | ||
Multiple RCTs have investigated the potential role for steroid therapy in patients with septic shock. The [[Annane Trial]] in 2002 demonstrated a short-term mortality benefit with IV hydrocortisone and fludrocortisone among patients with evidence of adrenal insufficiency on ACTH stimulation testing. [[CORTICUS]] in 2008 investigated hydrocortisone in patients with and without adrenal insufficiency and found no benefit in either subgroup with suggestion of increased infection rates in patients receiving hydrocortisone. Most recently [[HYPRESS]], published 2016, demonstrated little benefit in advancing septic shock but no excess infections in the treatment group. | Multiple RCTs have investigated the potential role for steroid therapy in patients with septic shock. The [[Annane Trial]] in 2002 demonstrated a short-term mortality benefit with IV hydrocortisone and fludrocortisone among patients with evidence of adrenal insufficiency on ACTH stimulation testing. [[CORTICUS]] in 2008 investigated hydrocortisone in patients with and without adrenal insufficiency and found no benefit in either subgroup with suggestion of increased infection rates in patients receiving hydrocortisone. Most recently [[HYPRESS]], published 2016, demonstrated little benefit in advancing septic shock but no excess infections in the treatment group. This trial was conducted between [[CORTICUS]] and [[HYPRESS]]. | ||
Vitamin C has been used for a variety of applications, for infection to oncologic applications, but often relegated to "quackery." Theoretically hydrocortisone should work synergistically with Vitamin C to help reverse some of the host inflammatory dysfunction. This trial took the combination of Vitamin C, hydrocortisone, and added thiamine to help clear one of the byproducts of Vitamin C metabolism and avoid renal damage. This small trial took 47 patients and compared them to historical comparators. The treatment group as compared to the historical cohort showed an absolute decrease of hospital mortality of 32% (P<0.001) as well as statistically significant decreases in duration of vasopressor therapy, the need of renal replacement therapy, procalcitonin clearance and decreases in SOFA score. | |||
There were a number of limitations with this trial. The small sample size increases the risk of bias with the effect. The lack of a concurrent comparator group also must make us cautiously interpret these findings. The generalizability is also limited due to the single centre design. As a feasiblity study, this now makes way for a larger RCT to be conducted to test this in a wider population. | |||
==Guidelines== | ==Guidelines== | ||