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.