Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study.
Level 4 - case-series / case-control
Retrospective before-after study with historical controls
PubMed 27940189 · doi:10.1016/j.chest.2016.11.036
What was done
A retrospective before-after clinical study compared consecutive ICU patients with severe sepsis or septic shock treated over a 7-month period with intravenous vitamin C, hydrocortisone, and thiamine (n = 47) against a control group treated in the same ICU during the preceding 7 months (n = 47). The primary outcome was hospital survival, adjusted using a propensity score. Vasopressor duration and changes in organ failure scores were also assessed.
What was found
Hospital mortality was 8.5% (4 of 47) in the treatment group compared with 40.4% (19 of 47) in the historical control group (P < .001). The propensity-adjusted odds of mortality in patients receiving the vitamin C protocol was 0.13 (95% CI, 0.04-0.48; P = .002). Vasopressors were weaned off after a mean of 18.3 ± 9.8 hours in the treatment group versus 54.9 ± 28.4 hours in the control group (P < .001). The Sepsis-Related Organ Failure Assessment score decreased in all patients in the treatment group, with none developing progressive organ failure.
Why it matters
This study generated widespread interest by suggesting that a low-cost, readily available combination of vitamin C, hydrocortisone, and thiamine could substantially reduce mortality and organ failure in severe sepsis and septic shock.
Limits
The study was a single-center retrospective before-after design with historical controls, making it vulnerable to confounding, selection bias, and temporal shifts in baseline care. The sample size was small (94 patients total), and treatments were unblinded.
Cited by
- supports A retrospective study treating 47 sepsis patients with IV vitamin C, hydrocortisone, and thiamine reported a hospital mortality rate of 8.5% compared to 40.4% in a matched control group.