Thiamine combined with vitamin C in sepsis or septic shock: a systematic review and meta-analysis

Link to article at PubMed

Eur J Emerg Med. 2021 Mar 9. doi: 10.1097/MEJ.0000000000000812. Online ahead of print.


BACKGROUND: Thiamine and vitamin C have been increasingly used in patients with sepsis or septic shock because of their potential for improving metabolism and reducing mortality.

OBJECTIVE: We aim to determine if thiamine combined vitamin C can reduce mortality in patients with sepsis or septic shock.

EVIDENCE SOURCES AND STUDY SELECTION: We comprehensively searched the PubMed, Embase, Cochrane Library, and Web of Science databases from their inception dates through 1 January 2021. Literature works evaluating the efficacy of thiamine combined vitamin C in patients with sepsis or septic shock were considered.

DATA EXTRACTION AND OUTCOME MEASUREMENTS: Two reviewers extracted data and assessed study quality. A meta-analysis was performed to calculate an odds ratio (OR), 95% confidence intervals (CIs), and P values for in-hospital mortality (primary outcome). Secondary outcomes included duration of ICU stay, duration of hospital stay, duration of vasopressor use, and change in sequential organ failure assessment (SOFA) scores.

RESULTS: Seven randomized controlled trials were identified, encompassing a total of 868 patients. There was no statistical difference between groups for in-hospital mortality (OR: 1.11; 95% CI [0.79-1.56]; P = 0.55). Other than improving SOFA score during the first 72 h after enrollment and duration of vasopressor use, we found no other significant associations.

CONCLUSIONS: Despite widespread enthusiasm for thiamine combined with vitamin C for sepsis and septic shock, we only found an association with reduced SOFA score and time of vasopressor use. There was no association with in-hospital mortality.

PMID:33709993 | DOI:10.1097/MEJ.0000000000000812

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