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. 2024 Dec;28(12):1147-1152.
doi: 10.5005/jp-journals-10071-24852. Epub 2024 Nov 30.

Evaluation of the Effects of a Combination of Vitamin C, Thiamine and Hydrocortisone vs Hydrocortisone Alone on ICU Outcome in Patients with Septic Shock: A Randomized Controlled Trial

Sachit Sharma  1 , Hem R Paneru  1 , Gentle S Shrestha  1 , Pramesh S Shrestha  1 , Subhash P Acharya  1
Affiliations

Evaluation of the Effects of a Combination of Vitamin C, Thiamine and Hydrocortisone vs Hydrocortisone Alone on ICU Outcome in Patients with Septic Shock: A Randomized Controlled Trial

Sachit Sharma et al. Indian J Crit Care Med. 2024 Dec.

Abstract

Aims and background: Glucocorticoids, vitamin C and thiamine have important biological effects in patients with sepsis and septic shock. Multiple studies have demonstrated the beneficial role of a combination therapy of vitamin C, hydrocortisone and thiamine in patients with sepsis and septic shock in terms of mortality reduction, and increase in the number of days free of ventilators and vasopressors.

Materials and methods: Patients who had septic shock were assessed for eligibility after intensive care unit (ICU) admission. After randomization, the treatment group received a combination of vitamin C, thiamine and hydrocortisone for a duration of 96 hours (16 doses) and the control group received hydrocortisone for a duration till the patient was on vasopressors. The primary outcome assessed was ICU mortality, and the key secondary outcome was the duration free of vasopressor administration at the end of 7 days.

Results: A total of 86 patients were included in the study. Seventy percent of patients in the control group and 58 percent in the intervention group died during ICU stay. None of the primary and secondary outcomes were statistically significant.

Conclusion: The use of a combination of vitamin C, hydrocortisone and thiamine has no added benefits over the use of hydrocortisone alone in patients with septic shock.

Clinical significance: The results of this clinical trial shows that the use of a combination of vitamin C, hydrocortisone and thiamine in patients with septic shock is not useful and should not be a routine practice in critically ill septic patients.

How to cite this article: Sharma S, Paneru HR, Shrestha GS, Shrestha PS, Acharya SP. Evaluation of the Effects of a Combination of Vitamin C, Thiamine and Hydrocortisone vs Hydrocortisone Alone on ICU Outcome in Patients with Septic Shock: A Randomized Controlled Trial. Indian J Crit Care Med 2024;28(12):1147-1152.

Keywords: Hydrocortisone; Intensive care unit; Septic shock; Thiamine; Vasopressors; Vitamin C.

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Conflict of interest statement

Source of support: Nil Conflict of interest: NoneConflict of interest: None

Figures

Fig. 1
Fig. 1
Flowchart depicting patient enrolment, allocation, follow-up and analysis in control and intervention groups
See this image and copyright information in PMC

References

    1. Singer M, Deutschman CS, Seymour C, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3) JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed
    1. Adhikari NKJ, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010;376(9749):1339–1346. doi: 10.1016/S0140-6736(10)60446-1. - DOI - PMC - PubMed
    1. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014;311(13):1308–1316. doi: 10.1001/jama.2014.2637. - DOI - PubMed
    1. Kadri SS, Rhee C, Strich JR, Morales MK, Hohmann S, Menchaca J, et al. Estimating ten-year trends in septic shock incidence and mortality in United States academic medical centers using clinical data. Chest. 2017;151(2):278–285. doi: 10.1016/j.chest.2016.07.010. - DOI - PMC - PubMed
    1. Silva E, Pedro M de A, Sogayar ACB, Mohovic T, Silva CL de O, Janiszewski M, et al. Brazilian sepsis epidemiological study (BASES study) Crit Care. 2004;8(4):R251–R260. doi: 10.1186/cc2892. - DOI - PMC - PubMed

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