OT: Hydrocortisone, Vitamin C and thiamine in the treatment of Sepsis

Since many of us- and our loved ones- spend time in hospitals, and since hospital acquired infections are a risk many of us take, and since they can lead to death via sepsis, I for one found this interesting for future reference. In addition, I.V. Vitamin C has been the subject of a few discussions re: it's possible ability to help in the battle against cancer. This study shows nothing about Vitamin C's usefulness against any cancer, but when it comes to fighting sepsis in ICU, I found this downright impressive, even spectacular considering the main additions to normal treatment appears to be 2 vitamins. I don't have the full article, and unfortunately the abstract does not tell us what the control treatment was. Since all are patients in ICU and this study is out of Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, I think it is reasonable to assume that the control group treatment is whatever the gold standard treatment for sepsis is, which quite likely includes Hydrocortisone(HC) already, in my experience. So I think the primary dif is either the addition of the vitamins(and maybe also HC) to the standard treatment(I'm betting on that), or use of vitamins and HC instead of whatever else was used. I don't know, and of course as usual it is just one study, but either way the treatment group response is most impressive. In fact, you rarely see results this impressive, even with a 100K new miracle drug. ( I also wished I knew what the comparative SEs were) So, for those who might be interested, here you go:
/www.ncbi.nlm.nih.gov/pubmed/27940189

Somebody said...

Format: Abstract

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Chest. 2016 Dec 6. pii: S0012-3692(16)62564-3. doi: 10.1016/j.chest.2016.11.036. [Epub ahead of print]
Hydrocortisone, Vitamin C and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study.
Marik PE1, Khangoora V2, Rivera R3, Hooper MH2, Catravas J4.
Author information

1Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA. Electronic address: [email protected].
2Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA.
3Department of Pharmacy, Sentara Norfolk General Hospital, 600 Gresham Drive, Norfolk, VA.
4School of Medical Diagnostic & Translational Sciences, College of Health Sciences, Old Dominion University; Departments of Medicine and Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA.

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) compared to 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.
FINDINGS:

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 to 40.4% (19 of 47) in the control group (p < 0.001). 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 SOFA score decreased in all patients in the treatment group with none developing progressive organ failure. Vasopressors were weaned off all patients in the treatment group, a mean of 18.3 ± 9.8 hours after starting treatment with vitamin C protocol. The mean duration of vasopressor use was 54.9 ± 28.4 hours in the control group (p<0.001).
CONCLUSION:

Our results suggest that the early use of intravenous vitamin C, together with corticosteroids and thiamine may prove to be effective in preventing progressive organ dysfunction including acute kidney injury and reducing the mortality of patients with severe sepsis and septic shock. Additional studies are required to confirm these preliminary findings.

Copyright © 2016. Published by Elsevier Inc.
KEYWORDS:

corticosteroid; hydrocortisone; sepsis; septic shock; thiamine; vitamin C

PMID:
27940189
DOI:
10.1016/j.chest.2016.11.036

[PubMed - as supplied by publisher]

Post Edited (BillyBob@388) : 3/6/2017 2:55:14 PM (GMT-7)

Corticosteroids like Hydrocortisone reduce mortality from sepsis, as reported in this study:
/www.ncbi.nlm.nih.gov/pubmed/19509383

Somebody said...
................Twenty-eight-day mortality for treated vs control patients was 388/1099 (35.3%) vs 400/1039 (38.5%) in randomized trials .............CONCLUSIONS:

Corticosteroid therapy has been used in varied doses for sepsis and related syndromes for more than 50 years, with no clear benefit on mortality. Since 1998, studies have consistently used prolonged low-dose corticosteroid therapy, and analysis of this subgroup suggests a beneficial drug effect on short-term mortality.....

and other similar results, though that is not in the ball park with the results of the study in the OP. What I would really like to know is was HC used in the control group, as it so often is?