A randomized clinical trial showed that combining Vitamin C and thiamine with standard steroid hydrocortisone did not improve the time of survival for patients with septic shock. The study titled, “Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial,” was published in the most recent issue of JAMA . The results were also presented at the Critical Care Reviews Meeting 2020 in Belfast, Northern Ireland. Image Credit: Numstocker / Shutterstock
There have been speculations regarding the additional benefits of combining Vitamin C and thiamine with standard hydrocortisone therapy for patients with septic shock. In this clinical trial the team included 216 patients with septic shock. The population was randomly assigned to receive either the combination of the three medications or intravenous hydrocortisone alone.
The authors wrote that sepsis is often life threatening and occurs due to an over active immune system that gets activated due to an overwhelming infection. This hyperactive immune system goes on to damage major organs leading to multi organ failure and septic shock. The team wrote that sepsis causes around one third to one half of all the hospital deaths. Over 5 million people across the globe die of sepsis the team wrote. In patients with septic shock there is a circulatory collapse for which the patient may require blood pressure raising medications or vasopressors. Studies have shown that high doses of vitamin C acting as an antioxidant can help in septic shock due to its anti-inflammatory properties. Thiamine too can help patients with septic shock because as many as one in five persons with sepsis are deficient of this vitamin write the researchers.
VITAMINS Trial Result from Critical Care Reviews on Vimeo .
This was a multicentric (based in 10 intensive care hospital set ups), open label (where all patients and/or family members knew if they were receiving the three drug combo or hydrocortisone alone), randomized (109 and 107 patients were randomly assigned to either study arm) clinical trial. The study was conducted across ICUs from Australia, New Zealand, and Brazil. The patients were defined as Sepsis-3 grade of septic shock. The study spanned between May 2018 and July 2019. The patients in the three drug arm received “intravenous vitamin C (1.5 g every 6 hours), hydrocortisone (50 mg every 6 hours), and thiamine (200 mg every 12 hours)” and the patients on the control arm received IV hydrocortisone 50 mg 6 hourly. The regimen for both arms was continued till there was resolution of symptoms or up to 10 days. Related Stories
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