Evidence map›Paper›PMID 32194058›Full record

Trial reportChest2020

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

Jose Iglesias, Andrew V Vassallo, Vishal V Patel, Jesse B Sullivan, Joseph Cavanaugh, Yasmine Elbaga

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Chest, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03422159 (Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis.), which is not on this map. Cited by 84 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
84citing papers in PubMed, 15 pooled it
17.2field-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.

NCT03422159 phase2completednot on this map

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%
3 · Its place in the literature

Who cites it

84 citing papers in PubMed, 15 syntheses or guidelines pooled it, 180 citations in OpenAlex.

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  2. Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2025
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  7. IV Vitamin C in Sepsis: A Latest Systematic Review and Meta-Analysis.International journal of clinical practice · 2023
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24 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 1 country.

Jose IglesiasDepartment of Critical Care, Department of Nephrology, Community Medical Center, Toms River, NJ; Department of Nephrology, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine at Seton Hall, Neptune, NJ. Electronic address: jiglesias23@gmail.com.
Andrew V VassalloDepartment of Pharmacy, Community Medical Center, Toms River, NJ.
Vishal V PatelDepartment of Pharmacy, Community Medical Center, Toms River, NJ.
Jesse B SullivanFairleigh Dickinson University School of Pharmacy & Health Sciences, Teaneck, NJ.
Joseph CavanaughDepartment of Pharmacy, Community Medical Center, Toms River, NJ.
Yasmine ElbagaDepartment of Pharmacy, Monmouth Medical Center Southern Campus, Lakewood, NJ.
Community Medical Center · USFairleigh Dickinson University · USJersey Shore University Medical Center · USMonmouth Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSepsis is a major public health burden resulting in 25% to 30% in-hospital mortality and accounting for over 20 billion dollars of US hospital costs. RESEARCH QUESTION: Does hydrocortisone, ascorbic acid, thiamine (HAT) therapy improve clinical outcomes in sepsis and septic shock? STUDY DESIGN AND

methodsThis was a randomized, double-blinded, placebo-controlled trial conducted from February 2018 to June 2019, assessing an HAT treatment bundle for the management of septic and septic shock patients admitted to an ICU. The primary outcomes were resolution of shock and change in Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes included 28-day mortality, ICU mortality, hospital mortality, procalcitonin clearance (PCT-c), hospital length of stay (LOS), ICU LOS, and ventilator-free days.

resultsOne hundred thirty-seven patients were randomized to the treatment group (n = 68) and comparator group (n = 69), respectively, with no significant differences in baseline characteristics. A statistically significant difference was found in the time patients required vasopressors, indicating quicker reversal of shock in the HAT group compared with the comparator group (27 ± 22 vs 53 ± 38 hours, P < .001). No statistically significant change in SOFA score was found between groups 3 (1 - 6) vs 2 (0 - 4), P = .17. No significant differences were found between study arms in ICU and hospital mortality, ICU and hospital LOS, ventilator free days, and PCT-c.

interpretationOur results suggest that the combination of IV ascorbic acid, thiamine, and hydrocortisone significantly reduced the time to resolution of shock. Additional studies are needed to confirm these findings and assess any potential mortality benefit from this treatment.

trial registrationClinicalTrials.gov; No.: NCT03422159; URL: www.clinicaltrials.gov.

Indexed as

AgedAged, 80 and overAscorbic AcidCritical CareDouble-Blind MethodDrug Therapy, CombinationFemaleGlucocorticoidsHumansHydrocortisoneMaleMiddle AgedSepsisSurvival RateThiamineVasoconstrictor AgentsAscorbic AcidGlucocorticoidsHydrocortisoneThiamineVasoconstrictor AgentsVitaminsascorbic acidHAT therapyhydrocortisonesepsisseptic shockthiaminevitamin c

Identifiers

PMID32194058
OpenAlexW3011612860

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

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.