Cited by 887Sepsis Diagnosis and TreatmentVitamin C and Antioxidants ResearchHyperglycemia and glycemic control in critically ill and hospitalized patients

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Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock

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Marik, Paul E., Khangoora, Vikramjit, Rivera, Racquel, Hooper, Michael H., Catravas, John·2017·Chest

DOI 10.1016/j.chest.2016.11.036

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Abstract

Background The global burden of sepsis is estimated as 15 to 19 million cases annually, with a mortality rate approaching 60% in low-income countries.Methods In this retrospective before-after clinical study, we compared the outcome and clinical course of consecutive septic patients treated with intravenous vitamin C, hydrocortisone, and thiamine during a 7-month period (treatment group) with a control group treated in our ICU during the preceding 7 months. The primary outcome was hospital survival. A propensity score was generated to adjust the primary outcome.Results There were 47 patients in both treatment and control groups, with no significant differences in baseline characteristics between the two groups. The hospital mortality was 8.5% (4 of 47) in the treatment group compared with 40.4% (19 of 47) in the control group (P < .001). The propensity adjusted odds of mortality in the patients treated with the vitamin C protocol was 0.13 (95% CI, 0.04-0.48; P = .002). The Sepsis-Related Organ Failure Assessment score decreased in all patients in the treatment group, with none developing progressive organ failure. All patients in the treatment group were weaned off vasopressors, a mean of 18.3 ± 9.8 h after starting treatment with the vitamin C protocol. The mean duration of vasopressor use was 54.9 ± 28.4 h in the control group (P < .001).Conclusions Our results suggest that the early use of intravenous vitamin C, together with corticosteroids and thiamine, are effective in preventing progressive organ dysfunction, including acute kidney injury, and in reducing the mortality of patients with severe sepsis and septic shock. Additional studies are required to confirm these preliminary findings.

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Authors: Marik, P. E., Khangoora, V., Rivera, R., Hooper, M. H., & Catravas, J.
Affiliations: Eastern Virginia Medical School (US)
Sentara Norfolk General Hospital (US)
Corresponding author: Marik, Paul E.
ORCID: Marik, Paul E.
Catravas, John
Venue: Chest
Publisher: Elsevier BV
Published: 2017-06
Volume: 151
Issue: 6
Pages: 1229-1238
ISSN: 0012-3692 (ISSN-L)
DOI: 10.1016/j.chest.2016.11.036
OpenAlex: W2560240742
Semantic Scholar: 1d6972ac35fc0d34a615e58cb9faf40d7e6f28cd
Cited by: 887
References: 95
Citations by year: 2026: 28 · 2025: 55 · 2024: 48 · 2023: 87 · 2022: 121 · 2021: 158 · 2020: 151 · 2019: 103 · 2018: 90 · 2017: 45
FWCI: 74.27
Type: journal article
Language: en
Update notices: addendum (2023-07-01)
Open access: green
digitalcommons.odu.edu
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: CHEST Journal (publishedVersion)
PubMed (publishedVersion)
ODU Digital Commons (Old Dominion University) (submittedVersion)
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
Health Sciences › Nursing › Nutrition and Dietetics › Vitamin C and Antioxidants Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Keywords: severe sepsis, septic shock, cortisol, intravenous vitamin C, thiamine, corticosteroids, in-hospital mortality, organ dysfunction, acute kidney injury, vasopressor weaning, sepsis-related organ failure assessment
MeSH terms: Adult, Aged, Anti-Inflammatory Agents, Antioxidants, Ascorbic Acid, Drug Therapy, Combination, Female, Humans, Hydrocortisone, Intensive Care Units, Male, Middle Aged, Retrospective Studies, Shock, Septic, Thiamine, Vasoconstrictor Agents, Vitamin B Complex, Treatment Outcome, Hospital Mortality, Sepsis, Acute Kidney Injury, Administration, Intravenous, Controlled Before-After Studies

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Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock

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