Hydrocortisone, vitamin C, and thiamine may not improve the outcome of patients with sepsis or septic shock: a systematic review and meta-analysis
Abstract. Background. This study aimed to conduct a systematic review and meta-analysis of the efficacy of hydrocortisone, vitamin C, and thiamine (HVT) in patients with sepsis or septic shock. Methods. A literature search was performed in PubMed, Embase, Cochrane Library, and Web of Science from th...
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Wolters Kluwer Health/LWW
2023-09-01
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| Series: | Emergency and Critical Care Medicine |
| Online Access: | http://journals.lww.com/10.1097/EC9.0000000000000072 |
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| author | Zhuangli Li Xiaoli Zhang Yongliang Wu Chao Xie Chengjiang Liu Xiuyu He Zehua Wu Guofang Hua Yuedong Li |
| author_facet | Zhuangli Li Xiaoli Zhang Yongliang Wu Chao Xie Chengjiang Liu Xiuyu He Zehua Wu Guofang Hua Yuedong Li |
| author_sort | Zhuangli Li |
| collection | DOAJ |
| description | Abstract. Background. This study aimed to conduct a systematic review and meta-analysis of the efficacy of hydrocortisone, vitamin C, and thiamine (HVT) in patients with sepsis or septic shock.
Methods. A literature search was performed in PubMed, Embase, Cochrane Library, and Web of Science from their inception to April 2021. Search terms included hydrocortisone, thiamine, vitamin C, sepsis, and septic shock. Only randomized controlled trials on HVT in treating sepsis and septic shock were analyzed. Risk ratio (RR) was generated using Review Manager 5.3 to evaluate binary variants, whereas mean ± standard deviation (MD) was generated to assess continuous variants.
Results. A total of 7 randomized controlled trials, with 1233 patients, were included in this meta-analysis. There was no significant difference in long-term mortality (35.3% vs 33.2%; RR: 1.07; 95% confidence interval [95% CI]: 0.90–1.27; P = 0.45; I2 = 0%), intensive care unit (ICU) mortality (17.4% vs 17.5%; RR: 0.99; 95% CI: 0.75–1.30; P = 0.95; I2 = 0%), in-hospital mortality (27.4% vs 25.8%; RR: 1.06; 95% CI: 0.84–1.34; P = 0.63; I2 = 0%), and acute kidney injury morbidity (RR: 1.04; 95% CI: 0.91–1.18; P = 0.60; I2 = 0%) between HVT and control groups. For continuous variables, there was no significant effect of HVT therapy on delta Sequential Organ Failure Assessment (△SOFA) score (MD: −0.44; 95% CI: −1.00 to 0.12; P = 0.12; I2 = 49%), length of ICU stay (MD: 0.43; 95% CI: −0.27 to 1.14; P = 0.23; I2 = 0%), and length of hospital stay (MD: 0.80; 95% CI: −0.38 to 1.97; P = 0.18; I2 = 0%). Only vasopressor duration was significantly reduced in the HVT group (MD: −17.75; 95% CI: −25.56 to −9.94; P < 0.00001; I2 = 38%). Vasopressor duration refers to the time to shock reversal. Alternatively, it is the amount of time (in hours) required for patients to withdraw all vasoactive medication support. Neither HVT nor control △SOFA reached statistical significance.
Conclusion. Hydrocortisone, vitamin C, and thiamine use was not associated with improved mortality, lower acute kidney injury incidence, lower △SOFA, and shorter ICU and in-hospital stays among patients with sepsis and septic shock. However, the use of vasopressors decreased significantly. Further direct head-to-head studies are needed. |
| format | Article |
| id | doaj-art-99fc9b5142bc4fc6b6def1731e94cd2d |
| institution | OA Journals |
| issn | 2097-0617 2693-860X |
| language | English |
| publishDate | 2023-09-01 |
| publisher | Wolters Kluwer Health/LWW |
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| series | Emergency and Critical Care Medicine |
| spelling | doaj-art-99fc9b5142bc4fc6b6def1731e94cd2d2025-08-20T02:08:11ZengWolters Kluwer Health/LWWEmergency and Critical Care Medicine2097-06172693-860X2023-09-013312212910.1097/EC9.0000000000000072202309000-00006Hydrocortisone, vitamin C, and thiamine may not improve the outcome of patients with sepsis or septic shock: a systematic review and meta-analysisZhuangli Li0Xiaoli Zhang1Yongliang Wu2Chao Xie3Chengjiang Liu4Xiuyu He5Zehua Wu6Guofang Hua7Yuedong Li8a Department of Critical Care Medicine, The 901 Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation Army, Clinic College, Anhui Medical University, Hefei, Anhui, Chinaa Department of Critical Care Medicine, The 901 Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation Army, Clinic College, Anhui Medical University, Hefei, Anhui, Chinaa Department of Critical Care Medicine, The 901 Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation Army, Clinic College, Anhui Medical University, Hefei, Anhui, Chinaa Department of Critical Care Medicine, The 901 Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation Army, Clinic College, Anhui Medical University, Hefei, Anhui, Chinab Department of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical University, Anqing, Anhui, China.a Department of Critical Care Medicine, The 901 Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation Army, Clinic College, Anhui Medical University, Hefei, Anhui, Chinaa Department of Critical Care Medicine, The 901 Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation Army, Clinic College, Anhui Medical University, Hefei, Anhui, Chinaa Department of Critical Care Medicine, The 901 Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation Army, Clinic College, Anhui Medical University, Hefei, Anhui, Chinaa Department of Critical Care Medicine, The 901 Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation Army, Clinic College, Anhui Medical University, Hefei, Anhui, ChinaAbstract. Background. This study aimed to conduct a systematic review and meta-analysis of the efficacy of hydrocortisone, vitamin C, and thiamine (HVT) in patients with sepsis or septic shock. Methods. A literature search was performed in PubMed, Embase, Cochrane Library, and Web of Science from their inception to April 2021. Search terms included hydrocortisone, thiamine, vitamin C, sepsis, and septic shock. Only randomized controlled trials on HVT in treating sepsis and septic shock were analyzed. Risk ratio (RR) was generated using Review Manager 5.3 to evaluate binary variants, whereas mean ± standard deviation (MD) was generated to assess continuous variants. Results. A total of 7 randomized controlled trials, with 1233 patients, were included in this meta-analysis. There was no significant difference in long-term mortality (35.3% vs 33.2%; RR: 1.07; 95% confidence interval [95% CI]: 0.90–1.27; P = 0.45; I2 = 0%), intensive care unit (ICU) mortality (17.4% vs 17.5%; RR: 0.99; 95% CI: 0.75–1.30; P = 0.95; I2 = 0%), in-hospital mortality (27.4% vs 25.8%; RR: 1.06; 95% CI: 0.84–1.34; P = 0.63; I2 = 0%), and acute kidney injury morbidity (RR: 1.04; 95% CI: 0.91–1.18; P = 0.60; I2 = 0%) between HVT and control groups. For continuous variables, there was no significant effect of HVT therapy on delta Sequential Organ Failure Assessment (△SOFA) score (MD: −0.44; 95% CI: −1.00 to 0.12; P = 0.12; I2 = 49%), length of ICU stay (MD: 0.43; 95% CI: −0.27 to 1.14; P = 0.23; I2 = 0%), and length of hospital stay (MD: 0.80; 95% CI: −0.38 to 1.97; P = 0.18; I2 = 0%). Only vasopressor duration was significantly reduced in the HVT group (MD: −17.75; 95% CI: −25.56 to −9.94; P < 0.00001; I2 = 38%). Vasopressor duration refers to the time to shock reversal. Alternatively, it is the amount of time (in hours) required for patients to withdraw all vasoactive medication support. Neither HVT nor control △SOFA reached statistical significance. Conclusion. Hydrocortisone, vitamin C, and thiamine use was not associated with improved mortality, lower acute kidney injury incidence, lower △SOFA, and shorter ICU and in-hospital stays among patients with sepsis and septic shock. However, the use of vasopressors decreased significantly. Further direct head-to-head studies are needed.http://journals.lww.com/10.1097/EC9.0000000000000072 |
| spellingShingle | Zhuangli Li Xiaoli Zhang Yongliang Wu Chao Xie Chengjiang Liu Xiuyu He Zehua Wu Guofang Hua Yuedong Li Hydrocortisone, vitamin C, and thiamine may not improve the outcome of patients with sepsis or septic shock: a systematic review and meta-analysis Emergency and Critical Care Medicine |
| title | Hydrocortisone, vitamin C, and thiamine may not improve the outcome of patients with sepsis or septic shock: a systematic review and meta-analysis |
| title_full | Hydrocortisone, vitamin C, and thiamine may not improve the outcome of patients with sepsis or septic shock: a systematic review and meta-analysis |
| title_fullStr | Hydrocortisone, vitamin C, and thiamine may not improve the outcome of patients with sepsis or septic shock: a systematic review and meta-analysis |
| title_full_unstemmed | Hydrocortisone, vitamin C, and thiamine may not improve the outcome of patients with sepsis or septic shock: a systematic review and meta-analysis |
| title_short | Hydrocortisone, vitamin C, and thiamine may not improve the outcome of patients with sepsis or septic shock: a systematic review and meta-analysis |
| title_sort | hydrocortisone vitamin c and thiamine may not improve the outcome of patients with sepsis or septic shock a systematic review and meta analysis |
| url | http://journals.lww.com/10.1097/EC9.0000000000000072 |
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