Author: Aaron Lessen, MD

Educational Pearls:

• Previously, trials had shown promising evidence that vitamin C may improve mortality rates in patients with sepsis or septic shock.
• A 2017 retrospective before-after study gave a "cocktail" of hydrocortisone, vitamin C, and thiamine to patients with severe sepsis or in septic shock and reported a decrease in mortality from 40% to 8%.
• A 2020 randomized controlled trial demonstrated that giving patients hydrocortisone, vitamin C, and thiamine showed no benefits in improving sepsis outcomes.
• Currently use of Vitamin C in sepsis and septic shock remains controversial due to lack of sufficient data

References

1) Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest. 2017;151(6):1229. Epub 2016 Dec 6.

2) Fujii T, Luethi N, Young PJ, et al. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA. 2020;323(5):423–431. doi:10.1001/jama.2019.22176

Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD