Background and importance The combination of thiamine/vitamin C/hydrocortisone has recently emerged as an adjunctive therapy for patients with septic shock (SS)
Aim and objectives To evaluate the use of the combination as a complementary treatment for SS.
Material and methods A retrospective, observational, cohort study was carried out in critically ill patients diagnosed with SS in an ICU between January 2018 and September 2019. Patients were divided into two cohorts: cohort A (had received standard therapy of intensive fluids, empirically broad spectrum antibiotics, prevention of vein thrombosis and norepinephrine as vasopressor therapy) and cohort B (in addition had received intravenous treatment with the combination). Demographic variables (age, gender) and clinical variables (comorbidities, SAPS-III, origin of sepsis, need for invasive mechanical ventilation (IVM) and extracorporeal membrane oxygenation (ECMO), baseline procalcitonin, acute renal failure and blood culture positive) were collected. Dosage and duration of combination treatment were collected in cohort B. Hospital mortality, length of stay (LOS), duration of IVM, requirement for renal replace technique (RRT) and duration of vasopressor treatment were assessed. Comparisons between the groups were performed with STATA V.14.2
Results A total of 115 patients with SS were included (59 in cohort A; 56 in cohort B). All demographic and baseline clinic characteristics were not significantly different between the groups except for immunosuppression (41 vs 28, p=0.048). Patients in cohort B received the combination a median of 3 (1–26) days at doses: vitamin C 1.5 g/6 hours (62.5%), 1 g/6 hours (16.1%), 1 g/24 hours (16.1%) and 0.5 g/24 hours (5.3%); thiamine 200 mg/12 hours (55.4%), 100 mg/24 hours (26.8%) and 100 mg/12 hours (17.8%); and hydrocortisone 50 mg/6 hours (53.6%) and 100 mg/8 hours (46.4%). Twenty-one patients received decreasing dose regimens. In 23 patients in cohort A, steroid treatment was necessary. The combination was prescribed on admission in 80.7% of patients, and in 11 patients the prescription was delayed for a median of 7 (2–16) days. No differences in mortality were observed (24 vs 21, p=0.450). Patients in cohort B required more IVM than those in cohort A (31 vs 19, p=0.014) for more days (19.42 vs 2.17, p=0.055), more RRT (27 vs 16, p=0.019) and LOS (10.64 vs 6.37, p=0.02).
Conclusion and relevance According to our results, it cannot be concluded that adding hydrocortisone/vitamin/thiamine to standard treatment reduces mortality, LOS or duration of vasopressors. However, there was a tendency to treat the most vulnerable patients (immunosuppressed patients, refractory sepsis and RRT). Variable dosage was used, and as a result of the study, a protocol was developed in the unit to standardise the use of the combination.
References and/or acknowledgements No conflict of interest.
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