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. 2025 Aug 13:12:1566422.
doi: 10.3389/fnut.2025.1566422. eCollection 2025.

Effects of different vitamins on individuals with septic shock: a Bayesian NMA of RCTs

Jinjin Tian  1 , Ling Long  2 , Dandan Li  1 , Yahan Liang  1 , Guinan Sun  3 , Wenjing Song  1 , Xizi Yue  1 , Limin Shen  2 , Heling Zhao  2 , Shan Ren  2
Affiliations

Effects of different vitamins on individuals with septic shock: a Bayesian NMA of RCTs

Jinjin Tian et al. Front Nutr. .

Abstract

Objective: To compare the effects of different vitamins on patients with septic shock (SS) through Bayesian network meta-analysis.

Methods: Randomized controlled trials (RCTs) on vitamins for septic shock patients were retrieved from PubMed, Embase, Cochrane Library, Web of Science, etc. The retrieval time was set from the establishment of the database to May 20, 2024. All relevant studies on vitamin treatment for septic shock were retrieved and screened according to the established inclusion and exclusion criteria. Intensive care unit (ICU) length of stay, mechanical ventilation time, Sequential Organ Failure Assessment (SOFA) scores after 24 h, total hospital stay, and 28-day mortality were used as outcome measures. The quality of the included studies was evaluated for risk of bias, and R software was used for data analysis.

Results: A total of 36 articles were included in the analysis, covering 4,473 patients with septic shock. The vitamins included vitamin B (VB), vitamin C (VC), vitamin D (VD), vitamin E (VE), hydroxocobalamin (HYD), and vitamin combinations such as hydrocortisone plus vitamin C plus vitamin B (HYDVCVB), vitamin D plus probiotics (VDP), vitamin C plus vitamin B (VCVB), and hydrocortisone plus vitamin C (HYDVC). The network meta-analysis results showed that in terms of ICU length of stay, VD was superior to the control group [mean difference (MD) = 4.57, 95% CI (1.01, 9.69)] and HYDVCVB [MD = 5.4, 95% CI (0.51, 11.66)], with statistically significant differences. In terms of mechanical ventilation time, VC, VD, VCVB, and HYDVCVB showed no statistically significant differences compared to the control group. Regarding the SOFA score after 24 h, VDP was superior to the control group [MD = 2.98, 95% CI (0.27, 5.62)], as well as HYDVCVB [MD = 3.32, 95% CI (0.59, 6.04)], VB [MD = 2.96, 95% CI (0.18, 5.67)], VC [MD = 2.91, 95% CI (0.17, 5.57)], VCVB [MD = 3.18, 95% CI (0.31, 5.9)], and VD [MD = 2.91, 95% CI (0.05, 5.71)], with statistically significant differences. In terms of total hospital stay, VD was superior to the control group [MD = 7.61, 95% CI (2.59, 12.63)], as well as HYDVCVB [MD = 7.71, 95% CI (2.55, 12.9)], VB [MD = 7.6, 95% CI (0.84, 14.39)], VC [MD = 9.93, 95% CI (3.9, 15.92)], and VCVB [MD = 8.1, 95% CI (1.79, 14.41)], with statistically significant differences. Regarding 28-day mortality, VB, VC, VD, VDP, VCVB, HYDVCVB showed no statistically significant differences compared to the control group.

Conclusion: In patients with septic shock, the use of VD shows certain advantages in reducing ICU length of stay and total hospital length of stay. Moreover, its combination with probiotics may help reduce the SOFA scores after 24 h. However, these interventions have not significantly impacted 28-day mortality or mechanical ventilation time.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, PROSPERO: CRD42024599094.

Keywords: network meta-analysis; septic shock; shock; vitamin D; vitamins.

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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 of the study process.
Figure 2
Figure 2
Risk of bias graph.
Figure 3
Figure 3
The impact of various vitamins on ICU duration of stay. (A) Network diagram illustrating the impact of various vitamins on ICU length of stay. (B) Forest plot illustrating the impact of various vitamins on ICU length of stay. (C) SUCRA plot illustrating the impact of various vitamins on ICU length of stay.
Figure 4
Figure 4
The effect of different vitamins on mechanical ventilation duration. (A) Network diagram illustrating the effect of treatment on mechanical ventilation duration. (B) Forest plot illustrating the effect of treatment on mechanical ventilation duration. (C) SUCRA plot illustrating the effect of treatment on mechanical ventilation duration.
Figure 5
Figure 5
The effect of different vitamins on SOFA scores after 24 h. (A) Network diagram illustrating the effect of treatment on SOFA score after 24 h. (B) Forest plot illustrating the effect of treatment on SOFA score after 24 h. (C) SUCRA plot illustrating the effect of treatment on SOFA score after 24 h.
Figure 6
Figure 6
The effect of treatment on total length of hospital stay. (A) Network diagram illustrating the effect of treatment on total length of hospital stay. (B) Forest plot illustrating the effect of treatment on total length of hospital stay. (C) SUCRA plot illustrating the effect of treatment on total length of hospital stay.
Figure 7
Figure 7
The effect of treatment on 28-day mortality. (A) Network diagram illustrating the effect of treatment on 28-day mortality. (B) Forest plot illustrating the effect of treatment on 28-day mortality. (C) SUCRA plot illustrating the effect of treatment on 28-day mortality.
See this image and copyright information in PMC

References

    1. Hager DN, Hooper MH, Bernard GR, Busse LW, Ely EW, Fowler AA, et al. The vitamin C, thiamine and steroids in sepsis (VICTAS) protocol: a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled, clinical trial. Trials. (2019) 20:1–16. 10.1186/s13063-019-3254-2 - DOI - PMC - PubMed
    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus definitions for sepsis and septic shock (sepsis-3). JAMA. (2016) 315:801–10. 10.1001/jama.2016.0287 - DOI - PMC - 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) 151:278–85. 10.1016/j.chest.2016.07.010 - DOI - PMC - PubMed
    1. Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. (2013) 41:1167–74. 10.1097/CCM.0b013e31827c09f8 - DOI - 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) 311:1308–16. 10.1001/jama.2014.2637 - DOI - PubMed

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