Thiamine, Ascorbic Acid, and Hydrocortisone As a Metabolic Resuscitation Cocktail in Sepsis: A Meta-Analysis of Randomized Controlled Trials With Trial Sequential Analysis.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
pubmed:
29
9
2021
medline:
25
11
2021
entrez:
28
9
2021
Statut:
ppublish
Résumé
Sepsis is a common condition in the ICU. Despite much research, its prognosis remains poor. In 2017, a retrospective before/after study reported promising results using a combination of thiamine, ascorbic acid, and hydrocortisone called "metabolic resuscitation cocktail" and several randomized controlled trials assessing its effectiveness were performed. We conducted a systematic review and meta-analysis of randomized controlled trials in septic ICU patients to assess the effects of this combination therapy. PubMed, Embase, and the Cochrane library databases were searched from inception to March of 2021. Data were extracted independently by two authors. The main outcome was the change in Sequential Organ Failure Assessment score within 72 hours. Secondary outcomes included renal composite endpoints (acute kidney injury) Kidney Disease - Improving Global Outcome organization stage 3 or need for renal replacement therapy, vasopressor duration, and 28-day mortality. We included randomized controlled trials with patients admitted to the ICU with sepsis or septic shock. The trials compared a combination of thiamine, ascorbic acid, and hydrocortisone to standard care or placebo in patients admitted to ICU with sepsis or septic shock. We included eight randomized controlled trials (n = 1,335 patients). Within 72 hours, the median of mean improvement was -1.8 and -3.2 in the control and intervention groups, respectively (eight randomized controlled trials, n = 1,253 patients); weighted mean difference -0.82 (95% CI, -1.15 to -0.48). Data were homogeneous and the funnel plot did not suggest any publication bias. Duration of vasopressor requirement was significantly reduced in the intervention group (six randomized controlled trials). There was no evidence of a difference regarding the ICU mortality and the renal composite outcome (acute kidney injury KDIGO 3 or need for renal replacement therapy, seven randomized controlled trials). Metabolic resuscitation cocktail administrated in ICU septic patients improves change in Sequential Organ Failure Assessment score within 72 hours. However, this improvement is modest and its clinical relevance is questionable. The impact on renal failure and mortality remains unclear.
Identifiants
pubmed: 34582409
doi: 10.1097/CCM.0000000000005262
pii: 00003246-202112000-00011
doi:
Substances chimiques
Drug Combinations
0
Ascorbic Acid
PQ6CK8PD0R
Hydrocortisone
WI4X0X7BPJ
Thiamine
X66NSO3N35
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2112-2120Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Dr. Legouis was supported by a young researcher grant from University Hospital of Geneva (PRD 20-2017-I). Drs. de Seigneux and Legouis were supported by a STARTER grant (RS03-25) from the HUG private foundation (the foundation of the Geneva University Hospitals and the University of Geneva’s Faculty of Medicine). Dr. de Seigneux was supported by a SNF grant SNSF PP00P3-187186/1. Dr. Faivre is the recipient of a grant from the Swiss National Science Foundation (323530_191224). Dr. Elia disclosed that she is employed by the University Hospital of Geneva, Switzerland and that she is on the editorial board of the European Journal of Anesthesiology. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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