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. 2022 Jan;48(1):16-24.
doi: 10.1007/s00134-021-06558-0. Epub 2021 Nov 9.

Effect of adjunctive vitamin C, glucocorticoids, and vitamin B1 on longer-term mortality in adults with sepsis or septic shock: a systematic review and a component network meta-analysis

Tomoko Fujii  1   2   3 , Georgia Salanti  4 , Alessandro Belletti  5 , Rinaldo Bellomo  6   7   8 , Anitra Carr  9 , Toshi A Furukawa  10 , Nora Luethi  6   11 , Yan Luo  10 , Alessandro Putzu  12 , Chiara Sartini  5 , Yasushi Tsujimoto  10   13 , Andrew A Udy  6   14 , Fumitaka Yanase  6   7 , Paul J Young  6   8   15   16
Affiliations

Effect of adjunctive vitamin C, glucocorticoids, and vitamin B1 on longer-term mortality in adults with sepsis or septic shock: a systematic review and a component network meta-analysis

Tomoko Fujii et al. Intensive Care Med. 2022 Jan.

Abstract

We aimed to compare the effects of vitamin C, glucocorticoids, vitamin B1, combinations of these drugs, and placebo or usual care on longer-term mortality in adults with sepsis or septic shock. MEDLINE, Embase, CENTRAL, ClinicalTrials.gov and WHO-ICTRP were searched. The final search was carried out on September 3rd, 2021. Multiple reviewers independently selected randomized controlled trials (RCTs) comparing very-high-dose vitamin C (≥ 12 g/day), high-dose vitamin C (< 12, ≥ 6 g/day), vitamin C (< 6 g/day), glucocorticoid (< 400 mg/day of hydrocortisone), vitamin B1, combinations of these drugs, and placebo/usual care. We performed random-effects network meta-analysis and, where applicable, a random-effects component network meta-analysis. We used the Confidence in Network Meta-Analysis framework to assess the degree of treatment effect certainty. The primary outcome was longer-term mortality (90-days to 1-year). Secondary outcomes were severity of organ dysfunction over 72 h, time to cessation of vasopressor therapy, and length of stay in intensive care unit (ICU). Forty-three RCTs (10,257 patients) were eligible. There were no significant differences in longer-term mortality between treatments and placebo/usual care or between treatments (10 RCTs, 7,096 patients, moderate to very-low-certainty). We did not find any evidence that vitamin C or B1 affect organ dysfunction or ICU length of stay. Adding glucocorticoid to other treatments shortened duration of vasopressor therapy (incremental mean difference, - 29.8 h [95% CI - 44.1 to - 15.5]) and ICU stay (incremental mean difference, - 1.3 days [95% CI - 2.2 to - 0.3]). Metabolic resuscitation with vitamin C, glucocorticoids, vitamin B1, or combinations of these drugs was not significantly associated with a decrease in longer-term mortality.

Keywords: Hydrocortisone; Network meta-analysis; Sepsis; Systematic review; Thiamine; Vitamin C.

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Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
Network graphs of all available pairwise comparisons between the eligible interventions assessing mortality. The size of the nodes represents the total number of trial arms for each treatment. The number on the edges shows the number of trials for each comparison. The colour of each edge represents the average risk of bias of the contributing studies (green = low, yellow = moderate, red = high). a Mortality from 90 days to 1 year. b Mortality at the longest follow-up
Fig. 2
Fig. 2
League table for comparisons of mortality from 90 days to 1 year and at the longest follow-up post-randomization
Fig. 3
Fig. 3
Summary of conidence in network estimates for the primary outcome
See this image and copyright information in PMC

Comment in

  • Vitamin C in sepsis.
    Young PJ, Lamontagne F, Fujii T. Young PJ, et al. Intensive Care Med. 2022 Nov;48(11):1621-1624. doi: 10.1007/s00134-022-06822-x. Epub 2022 Aug 12. Intensive Care Med. 2022. PMID: 35960273 No abstract available.

References

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