Septic shock: combination of vitamin C, thiamine, and steroids doesn’t deliver

  • Fujii T & al.
  • JAMA
  • 17 ene. 2020

  • de Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • Nonblinded.
  • Modest sample size.
  • Thiamine levels not measured.
  • Secondary outcomes underpowered.