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Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock
Open accessAbstract
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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“Oxidative stress, defined as an imbalance between increased reactive oxygen and nitrogen species and endogenous antioxidant mechanisms, is observed in severe critical care conditions requiring mechanical ventilation (280), such as septic shock, severe pancreatitis, ARDS, major burns and trauma”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [280]
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“Hospital mortality was 8.5% in the treatment group compared with 40.4% in the control group (p < 0.001) [85].”
From Nutrition in Sepsis: A Bench-to-Bedside Review. (2020) · cites this paper as [85]
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“A secondary analysis of five observational studies identified a plateau pressure cut-off value of 29 cm H 2 O, above which an ordinal increment was accompanied by an increment of risk of death (436).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [436]
Experimental — accuracy not yet measuredIn the citing paper
“In 2017, a single centre before and after study reported shorter duration of vasopressor therapy and lower mortality following the administration of combination of high dose vitamin C, hydrocortisone, and thiamine to patients with sepsis and septic shock [521].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [521]
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Metadata
- 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.
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2017-06
- Volume
- 151
- Issue
- 6
- Pages
- 1229-1238
- ISSN
- 0012-3692 (ISSN-L)
- 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
- 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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