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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 14:06, 30 August 2021
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Vitamin C is an antioxidant that is vital to immune function. Its role in sepsis, and if it may synergistically reduce inflammation along with hydrocortisone, is unknown. Published in 2017 in Chest, Marik and colleagues sought to understand the potential role of Vitamin C, hydrocortisone, and thiamine in severe sepsis and septic shock. This small, single-center trial administered these agents to 47 patients and compared them to historical controls. The treatment group as compared to the historical controls 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. | Vitamin C is an antioxidant that is vital to immune function. Its role in sepsis, and if it may synergistically reduce inflammation along with hydrocortisone, is unknown. Published in 2017 in Chest, Marik and colleagues sought to understand the potential role of Vitamin C, hydrocortisone, and thiamine in severe sepsis and septic shock. This small, single-center trial administered these agents to 47 patients and compared them to historical controls. The treatment group as compared to the historical controls 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 extremely cautious in interpreting these findings. For context, the use of historical controls has been identified as the second-lowest level of evidence quality in the Global Health Evidence Framework.<ref>[https://www.ncbi.nlm.nih.gov/books/NBK121300/table/appb.t21/ Shekelle PG, et al. Global Health Evidence Framework. ''Southern California Evidence-based Practice Center.'' 2013.]</ref> The generalizability is also limited due to the single centre design | 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 extremely cautious in interpreting these findings. For context, the use of historical controls has been identified as the second-lowest level of evidence quality in the Global Health Evidence Framework.<ref>[https://www.ncbi.nlm.nih.gov/books/NBK121300/table/appb.t21/ Shekelle PG, et al. Global Health Evidence Framework. ''Southern California Evidence-based Practice Center.'' 2013.]</ref> The generalizability is also limited due to the single centre design. By itself, this study is low-quality evidence and should not be used to drive management of patients with severe sepsis and septic shock. | ||
More recently, the 2020 [[VITAMINS]] study found no benefit for the protocol in the present study. | |||
==Guidelines== | ==Guidelines== | ||