Thiamine deficiency in critically ill patients with sepsis.
OBJECTIVE
The objective of the study was to determine the prevalence of absolute thiamine deficiency (TD) in critically ill patients with sepsis and to examine the association between thiamine levels and lactic acidosis.


METHODS
This was a prospective, observational study.


METHODS
The setting was an urban, tertiary care center with approximately 50,000 emergency department visits per year and intensive care units numbering approximately 50 total beds.


METHODS
Thirty study patients admitted with clinical suspicion of infection and evidence of tissue hypoperfusion, as defined by a lactic acid level greater than 4 mmol/L or hypotension (systolic blood pressure <90 mm Hg) requiring vasopressor support, were enrolled. A control group of 30 patients presenting to the emergency department with minor emergencies was also enrolled.


METHODS
There were no interventions.


RESULTS
Plasma thiamine levels were measured at 0, 24, 48, 72, and 162 hours for patients in the study group. Absolute TD was defined as less than or equal to 9 nmol/L derived from established abnormal ranges per Quest laboratory. In the study group, 3 (10%) of 30 had absolute TD upon presentation; and an additional 3 patients (6/30, 20%) developed TD within 72 hours. None of the 30 controls (0/30, 0%) exhibited absolute TD. Of the vasopressor-dependent population, 7.7% (2/26) displayed TD on presentation. For the group overall, there was no correlation between thiamine and lactic acidosis. However, in patients without liver dysfunction, thiamine was statistically significantly negatively correlated with lactic acidosis (r = -.50; P = .02). The relationship between thiamine and lactic acidosis held after multivariable regression analysis controlling for age, sex, and comorbid disease (P < .02).


CONCLUSIONS
These preliminary findings indicate that critically ill patients may present with TD or develop this deficiency during their acute illness. We also identified a potential association between thiamine levels and lactic acidosis in patients without significant liver injury.
Donnino
Michael W
MW
Department of Emergency Medicine and Internal Medicine, Division of Pulmonary/Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. mdonnino@bidmc.harvard.edu
Carney
Erin
E
Cocchi
Michael N
MN
Barbash
Ian
I
Chase
Maureen
M
Joyce
Nina
N
Chou
Peter P
PP
Ngo
Long
L
D000140:Acidosis, Lactic / Q000097:blood*; D000328:Adult; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000150:complications*; D013831:Thiamine / Q000097:blood*; D013832:Thiamine Deficiency / Q000150:complications / Q000453:epidemiology*; D019037:Urban Health Services
D013831:Thiamine