Clinical

Benefit of combined ascorbic acid, corticosteroids, and thiamine in septic shock remains unproven


 

Background: Sepsis is a common reason for hospitalization, and studies of the combination of ascorbic acid, corticosteroids, and thiamine have had conflicting results.

Study design: Double-blind randomized controlled trial.

Setting: 14 hospitals in the United States.

Synopsis: A total of 205 patients were randomly assigned to receive parenteral ascorbic acid, hydrocortisone, and thiamine every 6 hours for 4 days or placebo in matching volumes and time points. The primary outcome was change in the Sequential Organ Failure Assessment (SOFA) score between enrollment and 72 hours. There was no statistically significant difference in SOFA scores (adjusted mean difference, –0.8; 95% CI, –1.7 to 0.2; P = .12), kidney failure (adjusted risk difference, 0.03; 95% CI, –0.1 to 0.2; P = .58), or 30-day mortality (HR, 1.3; 95% CI 0.8-2.2; P = .26) between the two groups. Adverse effects included hyperglycemia, hypernatremia, and new hospital-acquired infection.

Bottom line: The combination of ascorbic acid, corticosteroids, and thiamine in patients with septic shock does not improve SOFA score.

Citation: Moskowitz A et al. Effect of ascorbic acid, corticosteroids, and thiamine on organ injury in septic shock: The ACTS randomized clinical trial. JAMA. 2020;324(7):642-50.

Dr. Wallenhorst is a hospitalist and palliative medicine physician at the Lexington (Ky) VA Health Care System.

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