VITAMIN C, THIAMINE AND HYDROCORTISONE IN SEPTIC SHOCK: A RETROSPECTIVE ANALYSISAbstract
Background: Sepsis leads to approximately 11 million deaths annually. Objectives: We studied the effectiveness of using a combination of intravenous hydrocortisone (50mg QID), Ascorbic Acid (1.5g QID), and Thiamine (200mg BD) (HAT) to reduce mortality among septic patients compared to a historical control group. Materials and Methods: This retrospective, observational study was conducted between January 2016 – February 2018. Our hospital mortality for septic shock is 55%. According to published literature, hospital mortality decreased from 40.4% to 8.5% with the HAT protocol. To detect a 31.9% mortality difference with 95% confidence and 80% power, a minimum sample size of 27 patients would be required in each group. We included 62 patients (31 per group) with septic shock. In the experimental group, patients in septic shock received the HAT drugs within 6 hrs and continued for 4 days. They were compared with a propensity score-matched historical control group. Results: Nineteen (61.29%) and twenty-seven (87%) patients in the control group received steroid and vitamin supplements (non-Vitamin C), respectively. The mortality was 54.83% in the control group and 41.93% in the HAT group (p=0.65). Time to shock reversal was 59.64+25.59 h in the control group and 58.82+24.31 hr in the HAT group (p=0.88). There was no difference in change of SOFA score, duration of ICU or hospital stay, or need for mechanical ventilation or renal replacement therapy. Conclusion: In this study, the HAT protocol did not show a statistically significant reduction in mortality in patients with septic shock.
Mariam Varsha Joseph, Zubair Umer Mohamed *, Dipu Sathyapalan, Merlin Moni, Sabarish Balachandran, Greeshma C. Ravindran, Fabia Edathadathil, Arya S. Kumar and Georgy Paniker
Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
29 November 2021
23 February 2022
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