SLR - September 2020 - Kiera M. Benge-Shea

Vitamin C and Thiamine are Associated with Lower Mortality in Sepsis

Reference: Byerly S, Parreco J, Soe-Lin H, Parks JJ, Lee EE, Shnaydman I, Mantero A, Yeh DD, Namias N, Rattan R. Vitamin C and Thiamine are Associated with Lower Mortality in Sepsis. J Trauma Acute Care Surg. 2020 Jul; 89(1):111-7.

Scientific Literature Review

Reviewed By: Kiera M. Benge-Shea, DPM 
Residency Program: SSM Health DePaul Hospital – Bridgeton, MO

Podiatric Relevance: This research is relevant to podiatric surgery especially when discussing severe diabetic foot infections that eventually develop sepsis. The information provided in this article is useful in its ability to equip physicians that work with sepsis to help better predict and enable successful outcomes for their patients. This article covers a study that evaluates the effect of vitamin C and Thiamine on mortality and lactate clearance in ICU patients. This article proposed that survival and lactate clearance would be improved when treated with thiamine and/or vitamin C.

Methods: Utilizing the eICU-CRD (a database consisting of data from 208 hospitals through the US from 2014-15) a retrospective review of septic patients were identified and then stratified based on administration of vitamin C, thiamine, both, or neither. This data was then compared against the primary outcome of in-hospital mortality and the secondary outcome of lactate clearance (lactate less than 2.0 mmol/L). This data was then run through a number of logistic regressions to look at outcomes based on these variables as well as demographic information. 

Results: For vitamin C only, the risk regression used suggested that vitamin C is associated with decrease in mortality but there was no association between vitamin C and lactate clearance. For thiamine only, there was an associated decrease in mortality and no evidence of any association with lactate clearance. For both vitamin C and thiamine, there again was no evidence of any association between lactate clearance and the combination treatment, but there was a decrease in mortality with this treatment. There also was a subgroup of this combination treatment that also received vasopressors and this group showed improved lactic acid clearance and decreased mortality. 

Conclusions: The authors found that there is significant evidence to suggest that thiamine and vitamin C administration in the face of sepsis can greatly reduce mortality. It was found that the treatments worked in synergy, providing superior outcomes when combined. The authors theorized that due to the antioxidant and anti-inflammatory effects of vitamin C it helps provide immune enhancing as well as cardioprotective components necessary in combating downstream effects of sepsis. Thiamine also shows inflammatory response reduction in those with liver conditions and the authors theorize may provide additional aid to overcoming organ dysfunction in the septic response. The authors also argue that due to the low cost nature of these therapies they provide a cost effective and therapeutically effective means for combating sepsis with minimal risk involved. The limitations of this study lies in the methods: the reliance on self reporting of hospitals of treatment dosages as well as differing sepsis criteria. This allows for some bias and inconsistencies to the degree of illness and potential efficacies of the treatment. As a podiatric physician, this is good information to have on hand as the information provided does indicate that these therapies provide substantial efficacy in reducing mortality rates and have minimal risk.

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