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Review Article
Meta-analysis
The efficacy of vitamin C, thiamine, and corticosteroid therapy in adult sepsis patients: a systematic review and meta-analysis
Manoj Kumar Reddy Somagutta, Maria Kezia Lourdes Pormento, Muhammad Adnan Khan, Alaa Hamdan, Namrata Hange, Manish KC, Sukrut Pagad, Molly Sanjay Jain, Sivasthikka Lingarajah, Vishal Sharma, Jaspreet Kaur, Bernard Emuze, Erkan Batti, Obumneme Jude Iloeje
Acute Crit Care. 2021;36(3):185-200.   Published online June 30, 2021
DOI: https://doi.org/10.4266/acc.2021.00108
  • 13,838 View
  • 447 Download
  • 10 Web of Science
  • 13 Crossref
AbstractAbstract PDFSupplementary Material
Previous studies have suggested favorable outcomes of hydrocortisone, ascorbic acid (vitamin C), and thiamine (HAT) therapy in patients with sepsis. However, similar results have not been duplicated in sequential studies. This meta-analysis aimed to reevaluate the value of HAT treatment in patients with sepsis. Electronic databases were searched up until October 2020 for any studies that compared the effect of HAT versus non-HAT use in patients with sepsis. Data from 15 studies (eight randomized controlled trials [RCTs] and seven cohort studies) involving 67,349 patients were included. The results from the RCTs show no significant benefit of triple therapy on hospital mortality (risk ratio [RR], 0.99; P=0.92; I2=0%); intensive care unit (ICU) mortality (RR, 0.77; P=0.20; I2=58%); ICU length of stay (weighted mean difference [WMD], 0.11; P=0.86; I2 =37%) or hospital length of stay (WMD: 0.57; P=0.49; I2=17%), and renal replacement therapy (RR, 0.64; P=0.44; I2=39%). The delta Sequential Organ Failure Assessment (SOFA) score favored treatment after a sensitivity analysis (WMD, –0.72; P=0.01; I2=32%). However, a significant effect was noted for the duration of vasopressor use (WMD, –25.49; P<0.001; I2=46%). The results from cohort studies have also shown no significant benefit of HAT therapy on hospital mortality, ICU mortality, ICU length of stay, length of hospital stay, the delta SOFA score, the use of renal replacement therapy, or vasopressor duration. HAT therapy significantly reduced the duration of vasopressor use and improved the SOFA score but appeared not to have significant benefits in other outcomes for patients with sepsis. Further RCTs can help understand its benefit exclusively.

Citations

Citations to this article as recorded by  
  • Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis
    Huoyan Liang, Qingqing Mu, Wenju Sun, Liming Liu, Simin Qiu, Zili Xu, Yuqing Cui, Yan Yan, Tongwen Sun
    Frontiers in Nutrition.2023;[Epub]     CrossRef
  • Insights Into Thiamine Supplementation in Patients With Septic Shock
    Nara Aline Costa, Amanda Gomes Pereira, Clara Sandra Araujo Sugizaki, Nayane Maria Vieira, Leonardo Rufino Garcia, Sérgio Alberto Rupp de Paiva, Leonardo Antonio Mamede Zornoff, Paula Schmidt Azevedo, Bertha Furlan Polegato, Marcos Ferreira Minicucci
    Frontiers in Medicine.2022;[Epub]     CrossRef
  • Vitamin C-induced Hemolysis: Meta-summary and Review of Literature
    Deven Juneja, Ravi Jain
    Indian Journal of Critical Care Medicine.2022; 26(2): 224.     CrossRef
  • Is it time to reconsider the administration of thiamine alone or in combination with vitamin C in critically ill patients? A meta-analysis of clinical trial studies
    Nafiseh Shokri-mashhadi, Ali Aliyari, Zahra Hajhashemy, Saeed Saadat, Mohammad Hossein Rouhani
    Journal of Intensive Care.2022;[Epub]     CrossRef
  • Parenteral Vitamin C in Patients with Severe Infection: A Systematic Review
    Arnav Agarwal, John Basmaji, Shannon M. Fernando, Fang Zhou Ge, Yingqi Xiao, Haseeb Faisal, Kimia Honarmand, Mathieu Hylands, Vincent Lau, Kimberley Lewis, Rachel Couban, François Lamontagne, Neill K. J. Adhikari
    NEJM Evidence.2022;[Epub]     CrossRef
  • Unanswered questions on the use of hydrocortisone, ascorbic acid, and thiamine therapy in sepsis and septic shock
    David Ragoonanan, Nicolas Tran, Veeshal Modi, Paige Morgan Nickelsen
    American Journal of Health-System Pharmacy.2022; 79(19): 1626.     CrossRef
  • Impacts of Corticosteroid Therapy at Acute Stage of Hospital-Onset Clostridioides difficile Infections
    Ching-Chi Lee, Jen-Chieh Lee, Chun-Wei Chiu, Pei-Jane Tsai, Wen-Chien Ko, Yuan-Pin Hung
    Infection and Drug Resistance.2022; Volume 15: 5387.     CrossRef
  • The impact of vitamin C-containing treatment on the mortality of patients with sepsis: A systematic review and meta-analysis of randomized controlled trials
    Ching-Yi Chen, Chien-Tung Chiu, Ho-Sheng Lee, Chih-Cheng Lai
    Journal of Infection and Public Health.2022; 15(12): 1514.     CrossRef
  • Role of high dose vitamin C in management of hospitalised COVID-19 patients: A minireview
    Deven Juneja, Anish Gupta, Sahil Kataria, Omender Singh
    World Journal of Virology.2022; 11(5): 300.     CrossRef
  • Current role of high dose vitamin C in sepsis management: A concise review
    Deven Juneja, Prashant Nasa, Ravi Jain
    World Journal of Critical Care Medicine.2022; 11(6): 349.     CrossRef
  • HYDROCORTISONE, ASCORBIC ACID, AND THIAMINE THERAPY DECREASE RENAL OXIDATIVE STRESS AND ACUTE KIDNEY INJURY IN MURINE SEPSIS
    John Kim, Allan Stolarski, Qiuyang Zhang, Katherine Wee, Daniel Remick
    Shock.2022; 58(5): 426.     CrossRef
  • Early administration of Vitamin C in patients with sepsis or septic shock in emergency departments: A multicenter, double blinded, randomized controlled trial: The C-EASIE trial protocol
    Stefanie Vandervelden, Lina Wauters, Jan Breuls, Steffen Fieuws, Philippe Vanhove, Ives Hubloue, Magali Bartiaux, Jacques Creteur, François Stifkens, Koen Monsieurs, Didier Desruelles, Elisa Panada
    PLOS ONE.2021; 16(11): e0259699.     CrossRef
  • Hydrocortisone, ascorbic acid, and thiamine (HAT) for sepsis and septic shock: a meta-analysis with sequential trial analysis
    Weilan Na, Huili Shen, Yichu Li, Dong Qu
    Journal of Intensive Care.2021;[Epub]     CrossRef
Original Article
Basic science and research
Prognostic Implication of Adrenocortical Response during the Course of Critical Illness
Jin Hwa Song, Jung Hee Kim, Sang-Min Lee, Jinwoo Lee
Acute Crit Care. 2019;34(1):38-45.   Published online January 30, 2019
DOI: https://doi.org/10.4266/acc.2018.00339
  • 7,011 View
  • 127 Download
  • 5 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary Material
Background
Critical illness-related corticosteroid insufficiency (CIRCI) and adrenocorticotropic hormone (ACTH)-cortisol dissociation are hormonal conditions frequently observed in patients in the intensive care unit (ICU). The aim of this study was to evaluate the association between ACTH-cortisol dissociation and clinical outcomes of critically ill patients. Methods: We retrospectively reviewed the medical records of 94 ICU patients who underwent two rapid cosyntropin tests during hospital admission and compared the clinical aspects of patients with and without ACTH-cortisol dissociation. ACTH-cortisol dissociation was defined as plasma ACTH and serum cortisol concentrations of <22 pmol/L and >600 nmol/L, respectively. Results: Dissociation was present in 30 of the 94 patients (31.9%). Patients with ACTH-cortisol dissociation in the initial test had significantly higher hospital mortality rate than those in the control group (55% vs. 25.7%, P=0.013) There was no difference in hospital mortality between patients classified as having CIRCI and those who were not. In multivariate adjusted Cox regression analysis, the mortality risk was higher in the group with ACTH-cortisol dissociation (hazard ratio, 2.98; 95% confidence interval, 1.34 to 6.63; P=0.007). Patients with dissociation in two consecutive stimulation tests showed the highest hospital mortality rate among groups classified according to stimulation test results (100% vs. 31.3%). Conclusions: The hospital mortality was higher in ICU patients diagnosed with ACTH-cortisol dissociation. It is clinically feasible to evaluate the presence of ACTH-cortisol dissociation by analyzing rapid ACTH stimulation test results in critically ill patients.

Citations

Citations to this article as recorded by  
  • Serum ACTH and Cortisol Level is Associated with the Acute Gastrointestinal Injury Grade in ICU Patients
    Wen Xu, Yuzhen Qiu, Hongping Qiu, Ming Zhong, Lei Li
    International Journal of General Medicine.2024; Volume 17: 127.     CrossRef
  • PROGNOSTIC VALUE OF LOW-DOSE ADRENOCORTICOTROPIC HORMONE TEST IN CRITICALLY ILL PATIENTS
    Ahmad B. Abdelrehim, Fatma M. Mohsen, Mostafa A. Haredi, Zeinab Abdel Hameed, Walaa H. Ibrahim
    Shock.2023; 59(6): 871.     CrossRef
  • Copeptin and stress-induced hyperglycemia in critically ill patients: A prospective study
    Lilian Rodrigues Henrique, Daisy Crispim, Tarsila Vieceli, Ariell Freires Schaeffer, Priscila Bellaver, Cristiane Bauermann Leitão, Tatiana Helena Rech, Antonio Palazón-Bru
    PLOS ONE.2021; 16(4): e0250035.     CrossRef
  • Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients
    Jung Hee Kim, Yoon Ji Kim, Sang-Min Lee, Jinwoo Lee
    Acute and Critical Care.2020; 35(3): 149.     CrossRef
ACC : Acute and Critical Care
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