Evidence map›Paper›PMID 38870923›Full record

SynthesisInternational archives of allergy and immunology2024

Efficacy and Safety of Hydrocortisone, Ascorbic Acid, and Thiamine Combination Therapy for the Management of Sepsis and Septic Shock: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Jiawen Deng, Qi Kang Zuo, Kaden Venugopal, Jay Hung, Areeba Zubair, Sara Blais, Victoria Porter, Myron Moskalyk, Kiyan Heybati

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in International archives of allergy and immunology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Jiawen DengTemerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Qi Kang ZuoUBC Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Kaden VenugopalFaculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Jay HungFaculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
Areeba ZubairTemerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Sara BlaisUBC Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Victoria PorterUBC Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Myron MoskalykBiostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Kiyan HeybatiMayo Clinic Alix School of Medicine (Jacksonville), Mayo Clinic, Jacksonville, Florida, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThis systematic review aimed to assess the efficacy and safety of hydrocortisone, ascorbic acid, and thiamine (HAT) combination therapy in patients with sepsis and septic shock.

methodsWe conducted a database search in MEDLINE, Embase, CENTRAL, Web of Science, and CNKI for randomised controlled trials (RCTs) comparing HAT against placebo/standard of care or against hydrocortisone in sepsis/septic shock patients. Outcomes included mortality, ICU/hospital length of stay (LOS), vasopressor durations, mechanical ventilation durations, change in SOFA at 72 h, and adverse events. RCT results were pooled in random-effects meta-analyses. Quality of evidence was assessed using GRADE.

resultsFifteen RCTs (N = 2,594) were included. At 72 h, HAT reduced SOFA scores from baseline (mean difference [MD] -1.16, 95% confidence interval [CI]: -1.58 to -0.74, I2 = 0%) compared to placebo/SoC, based on moderate quality of evidence. HAT also reduced the duration of vasopressor use (MD -18.80 h, 95% CI: -23.67 to -13.93, I2 = 64%) compared to placebo/SoC, based on moderate quality of evidence. HAT increased hospital LOS (MD 2.05 days, 95% CI: 0.15-3.95, I2 = 57%) compared to placebo/SoC, based on very low quality of evidence. HAT did not increase incidence of adverse events compared to placebo/SoC.

conclusionsHAT appears beneficial in reducing vasopressor use and improving organ function in sepsis/septic shock patients. However, its advantages over hydrocortisone alone remain unclear. Future research should use hydrocortisone comparators and distinguish between sepsis-specific and comorbidity- or care-withdrawal-related mortality.

Indexed as

Ascorbic AcidHydrocortisoneSepsisShock, SepticThiamineDrug Therapy, CombinationHumansLength of StayRandomized Controlled Trials as TopicTreatment OutcomeAscorbic AcidHydrocortisoneThiamineAscorbic acidHydrocortisoneMeta-analysisSepsisSeptic shockSystematic reviewThiamine

Identifiers

PMID38870923
PMCPMC11446305

What OpenQuestion holds

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Registered trials

None linked

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.