Readily
available vitamin therapy can help prevent sepsis shock and death

Vitamin C, corticosteroids, and thiamine administered together may help
prevent progressive organ failure caused by sepsis, according to a new study

Date:

June 26, 2017

Source:

Elsevier

Summary:

Even in
advanced medical settings, sepsis is still very dangerous and accounts for over
400,000 deaths annually in the US alone. While new drugs are in development, a
group of researchers has determined that a combination of intravenous vitamin
C, corticosteroids (a steroid), and thiamine (vitamin B) may be effective in
preventing progressive organ dysfunction and reducing the number of deaths from
severe sepsis and septic shock.

Predicted (based on APACHE 4
score) and actual hospital mortality in the treatment and control groups.

Credit: CHEST

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Sepsis presents a major
challenge for health care providers, especially in low-income countries where
the mortality rate can exceed 60 percent. Even in advanced medical settings,
sepsis is still very dangerous and accounts for over 400,000 deaths annually in
the U.S. alone. While new drugs are in development, a group of researchers has
determined that a combination of intravenous vitamin C, corticosteroids (a
steroid), and thiamine (vitamin B) may be effective in preventing progressive organ
dysfunction and reducing the number of deaths from severe sepsis and septic
shock. Their findings are published in the June issue of CHEST.

“New therapeutic
approaches to sepsis are desperately required,” explained lead
investigator Paul E. Marik, MD, Chief, Pulmonary and Critical Care Medicine,
Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA.
“Our results suggest that early use of intravenous vitamin C, together
with corticosteroids and thiamine may prove to be effective in preventing
progressive organ dysfunction, including acute kidney injury, and reducing the
mortality of patients with severe sepsis and septic shock.”

In this observational
before-and-after study, investigators looked at patients treated with their
“metabolic resuscitation protocol” of vitamin C, corticosteroids, and
thiamine. After finding early success with three seemingly terminal cases,
researchers treated patients with sepsis in their ICU using the cocktail. The
team then established a control group by examining medical records of similar
patients who had been hospitalized prior to the initiation of the new protocol.
They found that patients who received this novel treatment improved much more
quickly than those in the control group and had a much lower hospital death
rate. In the control group not treated with the protocol, 40 percent of
patients died in the hospital versus 9 percent in the treatment group.

Along with fewer deaths,
the protocol also reduced the duration of vasopressor use. In the control
group, the mean duration for vasopressor use was 54.9 ? 28.4 hours, but in the
treatment group, that time was significantly reduced to 18.3 ? 9.8 hours. Also
of note, no patient in the treatment group developed progressive organ failure,
and the four deaths in the group were not from sepsis but from underlying
medical conditions they had before developing sepsis.

Investigators believe
that the combination of vitamin C, hydrocortisone and thiamine works
synergistically to reverse the pathophysiologic changes of sepsis. Vitamin C is
a crucial antioxidant, vital to preserving endothelial function and
microcirculatory flow. Predictably, patients with sepsis have very low serum
levels of vitamin C that can only be corrected through the administration of
intravenous vitamin C. In the study, patients were given 6 g of vitamin C per
day, for which no complications or side effects have been reported, along with
hydrocortisone doses according to consensus guidelines from the American
College of Critical Care Medicine. Thiamine was included to combat thiamine
deficiency, which has been linked to an increased risk of death in patients
with sepsis.

While other studies have
examined the safety and efficacy of these components by themselves, this is the
first study to evaluate them together. “We did not test an expensive,
proprietary designer molecule, but rather a combination of three cheap and
readily available agents with a long safety record in clinical use since
1949,” concluded Dr. Marik. “Due to the inherent safety of the
combination of hydrocortisone, vitamin C, and thiamine, we believe that this
treatment strategy can be adopted pending the results of further clinical
trials. This inexpensive intervention has the potential to reduce the global
mortality for sepsis.” Dr. Marik also acknowledged all those scientists
dating back to 1747, who have done seminal research in this area and on whose
work this study concept was based.

Story Source:

Materials provided by Elsevier. Note:
Content may be edited for style and length.

Journal Reference:

1.    Paul E. Marik, Vikramjit
Khangoora, Racquel Rivera, Michael H. Hooper, John Catravas. Hydrocortisone,
Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock.
Chest, 2017; 151 (6): 1229 DOI: 10.1016/j.chest.2016.11.036

Elsevier.
“Readily available drug cocktail can help prevent sepsis shock and death:
Vitamin C, corticosteroids, and thiamine administered together may help prevent
progressive organ failure caused by sepsis, according to a new study.”
ScienceDaily. ScienceDaily, 26 June 2017.
<www.sciencedaily.com/releases/2017/06/170626105751.htm>.