Observational Study

. 2018 Feb:43:61-64.

doi: 10.1016/j.jcrc.2017.08.022. Epub 2017 Aug 16.

Thiamine in septic shock patients with alcohol use disorders: An observational pilot study

Mathias Johan Holmberg¹, Ari Moskowitz², Parth Vijay Patel³, Anne Victoria Grossestreuer⁴, Amy Uber⁵, Nikola Stankovic⁶, Lars Wiuff Andersen⁷, Michael William Donnino⁸

Affiliations

¹ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. Electronic address: mholmber@bidmc.harvard.edu.
² Department of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: amoskowi@bidmc.harvard.edu.
³ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: pvpatel@bidmc.harvard.edu.
⁴ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: agrosses@bidmc.harvard.edu.
⁵ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: auber@bidmc.harvard.edu.
⁶ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. Electronic address: nstankov@bidmc.harvard.edu.
⁷ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. Electronic address: lwandersen@clin.au.dk.
⁸ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: mdonnino@bidmc.harvard.edu.

PMID: 28850930
PMCID: PMC5732860
DOI: 10.1016/j.jcrc.2017.08.022

Observational Study

Thiamine in septic shock patients with alcohol use disorders: An observational pilot study

Mathias Johan Holmberg et al. J Crit Care. 2018 Feb.

. 2018 Feb:43:61-64.

doi: 10.1016/j.jcrc.2017.08.022. Epub 2017 Aug 16.

Authors

Mathias Johan Holmberg¹, Ari Moskowitz², Parth Vijay Patel³, Anne Victoria Grossestreuer⁴, Amy Uber⁵, Nikola Stankovic⁶, Lars Wiuff Andersen⁷, Michael William Donnino⁸

Affiliations

¹ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. Electronic address: mholmber@bidmc.harvard.edu.
² Department of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: amoskowi@bidmc.harvard.edu.
³ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: pvpatel@bidmc.harvard.edu.
⁴ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: agrosses@bidmc.harvard.edu.
⁵ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: auber@bidmc.harvard.edu.
⁶ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. Electronic address: nstankov@bidmc.harvard.edu.
⁷ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. Electronic address: lwandersen@clin.au.dk.
⁸ Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: mdonnino@bidmc.harvard.edu.

PMID: 28850930
PMCID: PMC5732860
DOI: 10.1016/j.jcrc.2017.08.022

Abstract

Purpose: Alcohol-use disorders (AUDs) have been associated with increased sepsis-related mortality. As patients with AUDs are often thiamine deficient, we investigated practice patterns relating to thiamine administration in patients with AUDs presenting with septic shock and explored the association between receipt of thiamine and mortality.

Materials: We performed a retrospective cohort study of patients presenting with septic shock between 2008 and 2014 at a single tertiary care center. We identified patients with an AUD diagnosis, orders for microbial cultures and use of antibiotics, vasopressor dependency, and lactate levels≥4mmol/L. We excluded those who received thiamine later than 48h of sepsis onset.

Results: We included 53 patients. Thirty-four (64%) patients received thiamine. Five patients (15%) received their first thiamine dose in the emergency department. The median time to thiamine administration was 9 (quartiles: 4, 18) hours. The first thiamine dose was most often given parenterally (68%) and for 100mg (88%). In those receiving thiamine, 15/34 (44%) died, compared to 15/19 (79%) of those not receiving thiamine, p=0.02.

Conclusions: A considerable proportion of patients with AUDs admitted for septic shock do not receive thiamine. Thiamine administration in this patient population was associated with decreased mortality.

Keywords: Alcohol use disorder; EtOH; Sepsis; Septic shock; Thiamine; Vitamin B1.

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Conflict of interest statement

CONFLICTS OF INTEREST

None

Figures

**Figure 1. Flow diagram for inclusion and exclusion criteria**
Out of 1,380 patients with a suspected infection, 53 patients met all inclusion and no exclusion criteria.

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Comment in

Adjunctive Therapies in the Management of Septic Shock.
Parikh R, Belok SH, Swamy L, Reardon CC. Parikh R, et al. Am J Respir Crit Care Med. 2019 Aug 1;200(3):381-383. doi: 10.1164/rccm.201810-1991RR. Am J Respir Crit Care Med. 2019. PMID: 30990750 No abstract available.

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Thiamine in septic shock patients with alcohol use disorders: An observational pilot study

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