Vitamin-C and thiamine have powerful experimental treatment effects suppressing mortality in critical care: implications for preventing patient deterioration in sepsis

Dr Simon Black

Background: Early antibiotics and appropriate fluid resuscitation have increased survival of patients with sepsis; however, mortality remains around 25%. Recently remote ischemic conditioning (RIC) was demonstrated to prevent sepsis-associated mortality. The biology of conditioning includes regulating mitochondrial function and preventing metabolic collapse associated with sepsis. Vitamin-C and thiamine mimic RIC and limits mitochondrial failure. Aim: The purpose of this study was to describe the effect-size of vitamin-C and thiamine in suppressing mortality amongst patients in critical care with presumed sepsis. Method: A systematic-like review was undertaken to identify controlled trials investigating the treatment effect of vitamin-C or thiamine on mortality in critical care. Results: Nine studies were identified that investigated the impact of vitamin-C on 3166 patients in comparison to 2900 control patients all with presumed sepsis. A significant treatment effect of vitamin-C was observed: Hedge’s g=0.339 (95% CI 0.071-0.607) p=0.013, Tau²=0.118. Seven studies of the effect of thiamine on 300 patients compared with 287 control patients all with presumed sepsis were identified. A significant treatment effect of thiamine was observed: Hedge’s g = 0.549 (95% CI 0.091-1.003 p=0.019, Tau² = 0.238. Discussion: Treatment effects of vitamin-C and thiamine for suppressing sepsis-related mortality were relatively homogeneous and large. Numbers Need to Treat (NNT) translated from the treatment effects was 5.279 for Vitamin-C and 3.321 for thiamine. Within an ongoing investigational paradigm, vitamin-C and thiamine could be considered potential adjunctive treatments for sepsis capable of reducing sepsis mortality. Pharmacologic induction of conditioning may become an important tool for maintaining patient safety.

Conference Committee

Dr Brian Doyle
Australasian College for Emergency Medicine (ACEM)

Bess Swinton & Ryan Posselt
Paramedics Australasia (PA)

Michael Browne
College of Emergency Nursing Australasia (CENA)

Important Dates

Early Bird - June 2018
Conference - 10 - 12 August 2018

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