Evidence map›Paper›PMID 27940189›Full record

ArticleChest2017

Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study.

Paul E Marik, Vikramjit Khangoora, Racquel Rivera, Michael H Hooper, John Catravas

13 registry-linked trialsOpen access · greenAbstract read
PubMed Publisher
In one paragraph

Article in Chest, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 13 registered trials, which are not on this map. Cited by 396 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
396citing papers in PubMed, 11 pooled it
58.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03258684 nacompletednot on this map

Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Sepsis and Septic Shock: A Prospective Study

TypeinterventionalSponsorZhujiang HospitalRan2017 to 2019Enrolled80ConditionsSepsisArmsHydrocortisone, Vitamin C, and Thiamine, Normal saline
NCT03335124 phase4terminatednot on this map

A Randomized, Double Blind, Placebo-Controlled Study to Investigate the Effects of Vitamin C, Hydrocortisone and Thiamine on the Outcome of Patients With Severe Sepsis and Septic Shock

TypeinterventionalSponsorUniversity Medical Centre LjubljanaRan2017 to 2018Enrolled5ConditionsSepsis, Septic Shock, Critical Illness, Fluid OverloadArmsVitamin C, Hydrocortisone, Thiamine, 0.9% Sodium Chloride Injection
NCT03380507 phase2 / phase3terminatednot on this mapstarted 2018, after this paper: background citation

Evaluation of Hydrocortisone, Vitamin C and Thiamine for the Treatment of Septic Shock

TypeinterventionalSponsorHamad Medical CorporationRan2018 to 2021Enrolled106ConditionsSeptic Shock, Critical IllnessArmsTriple therapy group
NCT03389555 phase2 / phase3completednot on this mapstarted 2018, after this paper: background citation

Ascorbic Ccid, Hydrocortisone, and Thiamine in Sepsis and Septic Shock - A Randomized, Double-Blind, Placebo-Controlled Trial

TypeinterventionalSponsorBeth Israel Deaconess Medical CenterRan2018 to 2020Enrolled205ConditionsSepsis, Septic Shock, Metabolic DisturbanceArmsvitamin C, vitamin B1, hydrocortisone, Normal saline
NCT03422159 phase2completednot on this mapstarted 2018, after this paper: background citation

Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis.

TypeinterventionalSponsorCommunity Medical Center, Toms River, NJRan2018 to 2019Enrolled140ConditionsSepsis, Severe, Septic ShockArmsAscorbic Acid, Thiamine, Hydrocortisone, Sodium Chloride 0.9%
NCT03451266 phase1completednot on this mapstarted 2018, after this paper: background citation

Effects of Vitamin C Administration on Extravascular Lung Water in Patients With Severe Features of Preeclampsia: a Randomized, Placebo-controlled Trial

TypeinterventionalSponsorUniversity Medical Centre LjubljanaRan2018 to 2019Enrolled34ConditionsPreeclampsia Severe, Preeclampsia PostpartumArmsVitamin C, placebo
NCT03509662 phase2completednot on this mapstarted 2019, after this paper: background citation

Early High-dose Vitamin C in Post-cardiac Arrest Syndrome

TypeinterventionalSponsorAmsterdam UMC, location VUmcRan2019 to 2024Enrolled270ConditionsCardiac ArrestArmsVitamin C, Thiamine, Placebos
NCT03592693 phase2terminatednot on this mapstarted 2018, after this paper: background citation

A Randomized, Double Blind, Placebo-Controlled Trial to Investigate the Effect of Vitamin C, Hydrocortisone and Thiamine on the Outcome of Patients with Septic Shock

TypeinterventionalSponsorUniversity of AthensRan2018 to 2023Enrolled24ConditionsShock, SepticArmsCombined Vitamin C and Stress-Dose Hydrocortisone, Placebo plus placebo
NCT03756220 phase2completednot on this mapstarted 2018, after this paper: background citation

Combination Therapy of Vitamin C and Thiamine for Septic Shock: Multi-center, Double-blinded, Randomized, Controlled Study

TypeinterventionalSponsorTae Gun ShinRan2018 to 2020Enrolled116ConditionsSeptic Shock, SepsisArmsCombination therapy of vitamin C and thiamine, Normal saline solution
NCT03828929 phase3terminatednot on this mapstarted 2019, after this paper: background citation

Effect of IV Vitamin C, Thiamine, and Steroids on Mortality of Septic Shock

TypeinterventionalSponsorNew York Presbyterian Brooklyn Methodist HospitalRan2019 to 2020Enrolled3ConditionsSeptic ShockArmsVitamin C, Normal saline
NCT04137276 nacompletednot on this mapstarted 2019, after this paper: background citation

Effect of Intravenous Vitamin C on Sequential Organ Failure Assessment (SOFA) Score Among Septic Patients: Randomized Controlled Trial

TypeinterventionalSponsorIndonesia UniversityRan2019 to 2019Enrolled33ConditionsSepsisArmsvitamin C, vitamin B1, vitamin B1
NCT05192213 phase3terminatednot on this mapstarted 2021, after this paper: background citation

Vitamin C, Hydrocortisone and Thiamine in Patients With Septic Shock: a Randomized Clinical Study (VITAMIN TRIAL)

TypeinterventionalSponsorHospital Sirio-LibanesRan2021 to 2022Enrolled71ConditionsSepsis, Septic ShockArmsVitamin C, Placebo
NCT05840718 completednot on this mapstarted 2023, after this paper: background citation

Impact of Thiamine Supplementation on Clinical Outcomes of Patients With Septic Shock: a Retrospective Before-after Study

TypeobservationalSponsorHospital Sao DomingosRan2023 to 2023Enrolled73ConditionsSeptic ShockArmsThiamin
3 · Its place in the literature

Who cites it

396 citing papers in PubMed, 11 syntheses or guidelines pooled it, 876 citations in OpenAlex.

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  6. Intravenous vitamin C use and risk of severity and mortality in COVID-19: A systematic review and meta-analysis.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2022
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336 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Paul E MarikDivision of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA. Electronic address: marikpe@evms.edu.
Vikramjit KhangooraDivision of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA.
Racquel RiveraDepartment of Pharmacy, Sentara Norfolk General Hospital, Norfolk, VA.
Michael H HooperDivision of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA.
John CatravasSchool 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.
Eastern Virginia Medical School · USSentara Norfolk General Hospital · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe global burden of sepsis is estimated as 15 to 19 million cases annually, with a mortality rate approaching 60% in low-income countries.

methodsIn 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.

resultsThere 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).

conclusionsOur 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.

Indexed as

Hospital MortalityAcute Kidney InjuryAdministration, IntravenousAdultAgedAnti-Inflammatory AgentsAntioxidantsAscorbic AcidControlled Before-After StudiesDrug Therapy, CombinationFemaleHumansHydrocortisoneIntensive Care UnitsMaleMiddle AgedAnti-Inflammatory AgentsAntioxidantsAscorbic AcidHydrocortisoneThiamineVasoconstrictor AgentsVitamin B Complexcorticosteroidhydrocortisoneseptic shockthiaminevitamin C

Identifiers

PMID27940189
OpenAlexW2560240742

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

and 7 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.