Chest
Volume 151, Issue 6, June 2017, Pages 1229-1238
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Original Research: Critical Care
Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study

https://doi.org/10.1016/j.chest.2016.11.036Get rights and content

Background

The global burden of sepsis is estimated as 15 to 19 million cases annually, with a mortality rate approaching 60% in low-income countries.

Methods

In this retrospective before-after clinical study, we compared the outcome and clinical course of consecutive septic patients treated with intravenous vitamin C, hydrocortisone, and thiamine during a 7-month period (treatment group) with a control group treated in our ICU during the preceding 7 months. The primary outcome was hospital survival. A propensity score was generated to adjust the primary outcome.

Results

There were 47 patients in both treatment and control groups, with no significant differences in baseline characteristics between the two groups. The hospital mortality was 8.5% (4 of 47) in the treatment group compared with 40.4% (19 of 47) in the control group (P < .001). The propensity adjusted odds of mortality in the patients treated with the vitamin C protocol was 0.13 (95% CI, 0.04-0.48; P = .002). The Sepsis-Related Organ Failure Assessment score decreased in all patients in the treatment group, with none developing progressive organ failure. All patients in the treatment group were weaned off vasopressors, a mean of 18.3 ± 9.8 h after starting treatment with the vitamin C protocol. The mean duration of vasopressor use was 54.9 ± 28.4 h in the control group (P < .001).

Conclusions

Our results suggest that the early use of intravenous vitamin C, together with corticosteroids and thiamine, are effective in preventing progressive organ dysfunction, including acute kidney injury, and in reducing the mortality of patients with severe sepsis and septic shock. Additional studies are required to confirm these preliminary findings.

Section snippets

Methods

This study was an electronic health record (EHR)-based retrospective before-after clinical study.28 The study was approved by our institutional review board (#16-08-WC-0179) and the Sentara Health System Office of Research (16-08-SRC-88) (see study protocol e-Appendix 1). This study was conducted at Sentara Norfolk General Hospital, a tertiary care referral hospital affiliated with Eastern Virginia Medical School and the only tertiary care facility in the Hampton Roads area, serving a

Results

There were 47 patients in each group. The baseline characteristics of the two groups are presented in Table 1; there were no significant differences in baseline characteristics between the two groups. Most patients had multiple comorbidities, with only two patients in the treatment group and one in the control group being previously “healthy.” The distribution of infections was similar between the two groups, with the lung being the most common site of infection. Blood cultures were positive in

Discussion

In this observational study the combination of intravenous vitamin C, moderate-dose hydrocortisone, and thiamine appeared to have a marked effect on the natural history of patients with severe sepsis and septic shock. No patient in the treatment group developed progressive organ failure, and the four deaths in this group were related to the patients’ underlying disease; these patients did not die of sepsis-related complications. Our study evaluated the use of intravenous vitamin C,

Acknowledgments

Author contributions: P. M. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. P. M.: Conception of study, literature review, pharmacologic modeling and interpretation, study design, study execution, data collection, data analysis, data interpretation, writing of study. V. K.: Literature review, study design, data analysis, data interpretation, writing of study. R. R.: Pharmacologic modeling and

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    FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

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