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Original Research |

Hydrocortisone, Vitamin C and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study

Paul E. Marik, MD, FCCM, FCCP; Vikramjit Khangoora, MD; Racquel Rivera, Pharm D; Michael H. Hooper, M.D., MSc; John Catravas, PhD, FAHA, FCCP
Author and Funding Information

Funding: None

COI: None of the authors have a conflict of interest to declare.

1Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA

2Department of Pharmacy, Sentara Norfolk General Hospital, 600 Gresham Drive, Norfolk, VA

3School of Medical Diagnostic & Translational Sciences, College of Health Sciences, Old Dominion University

4Departments of Medicine and Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA

Address for Correspondence: Paul E. Marik, MD, FCCM, FCCP Professor of Medicine Chief, Pulmonary and Critical Care Medicine Eastern Virginia Medical School 825 Fairfax Ave, Suite 410 Norfolk, VA 23507.


Copyright 2016, . All Rights Reserved.


Chest. 2016. 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) 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.


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