Category: Professional Posters
Purpose: Sepsis remains a common cause of mortality among critically ill patients. In 2017 Marik et al. provided a unique rationale and compelling evidence for the use of vitamin C, hydrocortisone, and thiamine in severe sepsis and septic shock. As a result of this study, intensivists at our community teaching hospital have implemented this adjunctive therapy in the intensive care units. The purpose of this study was to evaluate outcomes in critically ill patients with severe sepsis or septic shock that have received vitamin C, hydrocortisone, and thiamine in comparison to a matched control group that did not receive this therapy.
Methods: This was an institutional review board approved, retrospective, pre-post matched cohort study conducted at 687 bed community teaching hospital. Patients were divided into a treatment group that received vitamin C, hydrocortisone, and thiamine and a control group that did not receive vitamin C or thiamine. These groups were matched by APACHE IV score. Inclusion criteria included patients ≥ 18 years of age with a diagnosis of severe sepsis or septic shock (defined as meeting ≥ 2 SIRS [systemic inflammatory response syndrome] criteria), procalcitonin (PCT) ≥ 2 ng/mL, in addition to patients in the treatment group having received four days of vitamin C treatment. Data was collected from July 2016 to June 2017 for the control group and July 2017 to March 2019 for the treatment group using Baycare eICU software and the hospital electronic medical record. The primary endpoint was in-hospital mortality. Secondary endpoints included intensive care unit (ICU) and hospital lengths of stay (LOS), ventilator and vasopressor duration, change in PCT over 72 hours, and hyperglycemia during ICU stay.
Results: A total of 100 patients were enrolled. There was no statistically significant difference between groups for baseline and demographic data with the exception of ventilator status and vasopressor use. There was a statistically significant higher number of patients in the vitamin C group compared to the control group on mechanical ventilation (35 versus 22; P = 0.009) and vasopressors (50 versus 37; P < 0.005) at baseline upon ICU admission. Otherwise, the patients in both groups were well-matched with mortality scores. For the primary endpoint of in-hospital mortality, there were 19 (38%) deaths in the vitamin C group versus 15 (30%) in the control group (P = 0.398). For the secondary endpoints, the vitamin C group had a significantly longer ICU and hospital LOS, vasopressor duration and hyperglycemia.
Conclusion: The results of this study show that vitamin C, hydrocortisone, and thiamine did not have a significant impact on in-hospital mortality in patients with severe sepsis or septic shock. Randomized controlled trials are needed in order to further define the role of vitamin C, hydrocortisone, and thiamine in the management of sepsis.