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. 2023 Sep 13:10:1223862.
doi: 10.3389/fmed.2023.1223862. eCollection 2023.

Thiamine as a metabolic resuscitator in septic shock: a meta-analysis of randomized controlled trials with trial sequential analysis

Frédéric Sangla  1 , Thomas Verissimo  2 , Anna Faivre  3 , Térence Glauser  4 , Saw Kian Cheah  5 , Benjamin Assouline  1 , Sebastian Sgardello  6 , David Legouis  1   2
Affiliations

Thiamine as a metabolic resuscitator in septic shock: a meta-analysis of randomized controlled trials with trial sequential analysis

Frédéric Sangla et al. Front Med (Lausanne). .

Abstract

Objective: Septic shock is one of the most common reasons for admission to the Intensive Care Unit (ICU) and is associated with high mortality. Fundamentally, its management rests on antibiotics, fluid therapy and vasopressor use while many adjunctive therapies have shown disappointing results. Thiamine has recently gained interest as a metabolic resuscitator, though recent trials have tempered this enthusiasm, more specifically when thiamine is associated with ascorbic acid. However, thiamine use alone has been poorly investigated.

Design: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in septic shock patients to assess the effects of thiamine without ascorbic acid as an adjunctive therapy.

Setting: PubMed, Embase and the Cochrane library databases were searched from inception to April of 2023. Data were extracted independently by two authors. The main outcome was mortality.

Subjects: We included RCTs comparing standard care using thiamine alone, to standard care or placebo, in patients admitted to the ICU with sepsis or septic shock.

Main results: We included 5 RCTs (n = 293 patients). In this analysis, use of thiamine alone did not significantly change mortality, RR 0.87 (95%CI 0.65; 1.16, I2 = 21%) p = 0.34.

Conclusion: Current RCTs did not show an improvement in mortality when using thiamine in septic shock patients as an adjunctive therapy. However, these trials are largely underpowered for a definitive conclusion to be drawn. Further studies are therefore needed to assess the effects of thiamine without ascorbic acid as an adjunctive therapy.

Keywords: intensive care medicine; sepsis; septic shock; thiamine; thiamine (B1).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram for the systematic review and meta-analysis.
Figure 2
Figure 2
Effect of thiamine in septic shock on mortality. (A) Funnel plot showing the precision of the studies (Standard Error, SE) against the treatment effect as risk ratio (RR). (B) Trial sequential analysis showing the cumulative Z-score among included studies, according to the number of patients included. The horizontal lines represent the significant threshold with alpha set to 5% (two-sided test). The converged lines represent trial sequential boundaries (significance boundaries) adjusted in such a way that the total Type I and II errors remain at the level set in the sample size calculation. (C) Forest plot showing the mean difference in mortality.
Figure 3
Figure 3
Effect of thiamine in septic shock on secondary outcomes. (A,B) Funnel plot showing the precision of the studies (Standard Error, SE) against the treatment effect as mean difference (MD) for SOFA reduction withn 4 days (A) and as risk ratio (RR) for need for RRT (B).
See this image and copyright information in PMC

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