Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis.

Early nutritional intervention with ascorbic acid and thiamine, when combined with hydrocortisone, may speed resolution of sepsis.



Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis.:

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Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis.

Chest. 2020 Mar 16;:

Authors: Iglesias J, Vassallo AV, Patel VV, Sullivan JB, Cavanaugh J, Elbaga Y

Abstract

BACKGROUND: Sepsis is a major public health burden resulting in 25-30% in-hospital mortality and accounting for over 20 billion dollars of United States hospital costs.

METHODS: This was a randomized, double-blinded, placebo controlled trial conducted from February 2018 to June 2019 assessing an ascorbic acid (AA), thiamine, and hydrocortisone (HAT) treatment bundle for the management of septic and septic shock patients admitted to an intensive care unit (ICU). The primary outcomes were resolution of shock and change in Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes included 28-day mortality, ICU mortality, hospital mortality, procalcitonin clearance (PCT-c), hospital length of stay (LOS), ICU LOS, and ventilator free days.

RESULTS: 137 patients were randomized to the treatment group (n = 68) and comparator group (n = 69) respectively with no significant differences in baseline characteristics. There was a statistically significant difference in the time patients required vasopressors indicating quicker reversal of shock in the HAT group compared to comparator group (27 ± 22 vs 53 ± 38 hours, p < 0.001). There was no statistically significant change in SOFA score between groups 3 (1 - 6) vs. 2 (0 - 4), p = 0.17. There were no significant differences between study arms in ICU and hospital mortality, ICU and hospital LOS, ventilator free days, and PCT-c.

CONCLUSION: Our results suggest that the combination of intravenous ascorbic acid, thiamine, and hydrocortisone significantly reduced the time to resolution of shock. Additional studies are needed to confirm these findings and assess any potential mortality benefit from this treatment.

PMID: 32194058 [PubMed - as supplied by publisher]