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. 2021 Dec 18;9(1):75.
doi: 10.1186/s40560-021-00589-x.

Hydrocortisone, ascorbic acid, and thiamine (HAT) for sepsis and septic shock: a meta-analysis with sequential trial analysis

Weilan Na  1 , Huili Shen  2 , Yichu Li  1 , Dong Qu  3
Affiliations

Hydrocortisone, ascorbic acid, and thiamine (HAT) for sepsis and septic shock: a meta-analysis with sequential trial analysis

Weilan Na et al. J Intensive Care. .

Abstract

Background: Sepsis is a primary global health threat and costs a lot, requiring effective and affordable treatments. We performed this meta-analysis to explore the treatment of hydrocortisone, ascorbic acid, and thiamine (HAT) in sepsis and septic shock.

Methods: We searched Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception to August 14, 2021. We included randomized controlled trials (RCTs) that evaluated the HAT treatments in sepsis and septic shock. The primary outcome was the change in SOFA score over the 72 h. The second outcomes were the hospital, and 28-/30-day mortality, the duration of vasopressors, PCT clearance, hospital length of stay (LOS), and ICU LOS. We performed a subgroup analysis and a trial sequential analysis (TSA). The Der Simonian-Laird random-effects models were used to report the pooled risk ratios (RR) or mean difference (MD) with confidence intervals (CI).

Results: Nine RCTs, enrolling 1427 patients of sepsis and septic shock treated with HAT (717) or only standard care (710), were included. There was a significant difference between the two groups in the change in SOFA score over the first 72 h (MD 0.65, 95% CI 0.30 to 1.00), the duration of vasopressors (MD - 18.16, 95% CI - 25.65 to - 10.68) and the PCT clearance (MD 14.54, 95% CI 0.64 to 28.43). In addition, there was no significant difference in the hospital mortality (RR 1.07, 95% CI 0.85 to 1.34), the 28-/30-day mortality (RR 0.96, 95% CI 0.80 to 1.15), the hospital LOS (MD 0.78, 95% CI - 0.30 to 1.86), and ICU LOS (MD 0.12, 95% CI - 0.53 to 0.78).

Conclusions: The HAT combination improves the SOFA score in the first 72 h and reduces the duration of vasopressors in patients with sepsis. Given the minor mean difference of the change in SOFA score, the mortality benefit has not been observed.

Trial registration: PROSPERO, CRD42020203166.

Keywords: Ascorbic acid; Hydrocortisone; Meta-analysis; Sepsis; Thiamine.

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Conflict of interest statement

We declare that there are no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram
Fig. 2
Fig. 2
Forest plot of the primary outcome. Legends Forest plot of the change in SOFA score over the first 72 h in the comparison between HAT treatment and control in sepsis and septic shock
Fig. 3
Fig. 3
Forest plots of the second outcomes. Legends Forest plots of the hospital mortality (a), 28-/30-day mortality (b), duration of vasopressors (hours) (c), procalcitonin clearance (d), hospital LOS (e), and ICU LOS (f) in the comparison between HAT treatment and control in sepsis and septic shock
Fig. 4
Fig. 4
Subgroup analysis, sensitivity analysis and TSA of the primary outcome. Legends: a Forest plots of the subgroup analysis for the change in SOFA score over the first 72 h. Septic shock was assessed as a subgroup. b Forest plots of the sensitivity analysis for the change in SOFA score over the first 72 h. Trials that excluded patients with renal failure at enrollment was assessed. c Trial sequential analysis for the change in SOFA score over the first 72 h. The blue cumulative z curve crossed the conventional monitoring boundary and the red trial sequential boundary for benefit (the pooled effect, 0.56; 95% CI 0.23–0.89; I2 = 0%). The required information size (RIS) was 1038 (a two-sided a of 0.05, β of 80%)
Fig. 5
Fig. 5
Funnel plot and risk of bias summary. Legends: a Funnel plot assessing publication bias. The dots represent individual studies. b risk of bias summary for the included studies
See this image and copyright information in PMC

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