title: Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study.
abstract: The global burden of sepsis is estimated as 15 to 19 million cases annually, with a mortality rate approaching 60% in low-income countries.
  
  
  
  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) with 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.
  
  
  
  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 with 40.4% (19 of 47) in the control group (P < .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 Sepsis-Related Organ Failure Assessment score decreased in all patients in the treatment group, with none developing progressive organ failure. All patients in the treatment group were weaned off vasopressors, a mean of 18.3 ± 9.8 h after starting treatment with the vitamin C protocol. The mean duration of vasopressor use was 54.9 ± 28.4 h in the control group (P < .001).
  
  
  
  Our results suggest that the early use of intravenous vitamin C, together with corticosteroids and thiamine, are effective in preventing progressive organ dysfunction, including acute kidney injury, and in reducing the mortality of patients with severe sepsis and septic shock. Additional studies are required to confirm these preliminary findings.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA. Electronic address: marikpe@evms.edu.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Marik
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: Vikramjit
authors.initials: V
authors.lastname: Khangoora
authors.affiliation: Department of Pharmacy, Sentara Norfolk General Hospital, Norfolk, VA.
authors.forename: Racquel
authors.initials: R
authors.lastname: Rivera
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Hooper
authors.affiliation: School of Medical Diagnostic & Translational Sciences, College of Health Sciences, Old Dominion University, Norfolk, VA; Department of Medicine and Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: John
authors.initials: J
authors.lastname: Catravas
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000627:therapeutic use*; D065187:Controlled Before-After Studies; D004359:Drug Therapy, Combination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000401:mortality; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D013831:Thiamine / Q000627:therapeutic use*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D000975:Antioxidants; D014662:Vasoconstrictor Agents; D014803:Vitamin B Complex; D001205:Ascorbic Acid; D006854:Hydrocortisone; D013831:Thiamine
keywords: corticosteroid; hydrocortisone; septic shock; thiamine; vitamin C