- For patients with septic shock, treatment with vitamin C, thiamine, and hydrocortisone does not appear to improve 7-day vasopressor-free survival vs hydrocortisone alone.
- Editorial argues against clinical vitamin C administration as well as further studies of the intervention.
Why this matters
- A 2017 observational study linked the intervention to markedly lower mortality.
- The current study detected no difference in a head-to-head comparison.
- Intervention vs controls (n=211):
- Primary outcome: 122.1 (interquartile range [IQR], 76.3-145.4) hours vs 124.6 (IQR, 82.1-147.0) hours.
- Median of all paired differences in primary outcome: −0.6 (95% CI, −8.3 to 7.2) hours (P=.83).
- 9 of 10 prespecified secondary outcomes: no significant differences.
- No serious adverse events.
- Multinational open-label randomized clinical VITAMINS trial in 10 ICUs (n=216).
- Patients with septic shock were randomly assigned to intravenous treatment with vitamin C, hydrocortisone, and thiamine (intervention group) vs hydrocortisone alone (control group).
- Those in the control group were permitted thiamine at clinician discretion.
- Treatment duration: 10 days or shock resolution.
- Outcome: time alive and free of vasopressor administration up to day 7.
- Funding: Nonprofit grants; Brazilian government.
- Modest sample size.
- Thiamine levels not measured.
- Secondary outcomes underpowered.