Combination therapy of thiamine, vitamin C and hydrocortisone in treating patients with sepsis and septic shock: a meta-analysis and trial sequential analysis

Renqi Yao; Yibing Zhu; Yue Yu; Zhixuan Li; Lixue Wang; Liyu Zheng; Jingyan Li; Huibin Huang; Guosheng Wu; Feng Zhu; Zhaofan Xia; Chao Ren; Yongming Yao

doi:10.1093/burnst/tkab040

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Combination therapy of thiamine, vitamin C and hydrocortisone in treating patients with sepsis and septic shock: a meta-analysis and trial sequential analysis

更新时间：2022-06-14

- Combination therapy of thiamine, vitamin C and hydrocortisone in treating patients with sepsis and septic shock: a meta-analysis and trial sequential analysis
- Combination therapy of thiamine, vitamin C and hydrocortisone in treating patients with sepsis and septic shock: a meta-analysis and trial sequential analysis
- Burns & Trauma 2021年9卷第1期
- 作者机构：
  
  1. Translational Medicine Research Center
  2. Department of Burn Surgery
  3. Research Unit of key techniques for treatment of burns and combined burns and trauma injury
  4. Medical Research and Biometrics Center
  5. Department of Cardiothoracic Surgery
  6. International Cooperation Laboratory on Signal Transduction
  7. Department of Emergency
  8. Department of Critical Care Medicine
  9. Medical ICU
- 作者简介：
- 基金信息：
  
  This work was supported by grants from the National Natural Science Foundation of China (Nos. 81730057, 81801935, 82002071), the Key Project of Military Medical Innovation Program of Chinese PLA (No. 18CXZ026), and the National Key Research and Development Program of China (No. 2017YFC1103302), CAMS Innovation Fund for Medical Sciences (2019-I2M-5-076), Achievements Supportive Fund (2018-CGPZ-B03), and Chinese Postdoctoral Science Foundation Grant (2019 M664003).
- DOI：10.1093/burnst/tkab040
  中图分类号：
- 纸质出版日期：2021，
  
  网络出版日期：2021-12-6，
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Renqi Yao, Yibing Zhu, Yue Yu, 等. Combination therapy of thiamine, vitamin C and hydrocortisone in treating patients with sepsis and septic shock: a meta-analysis and trial sequential analysis[J]. Burns & Trauma, 2021,9(1).

Renqi Yao, Yibing Zhu, Yue Yu, Zhixuan Li, Lixue Wang, Liyu Zheng, Jingyan Li, Huibin Huang, Guosheng Wu, Feng Zhu, Zhaofan Xia, Chao Ren, Yongming Yao, Combination therapy of thiamine, vitamin C and hydrocortisone in treating patients with sepsis and septic shock: a meta-analysis and trial sequential analysis, Burns & Trauma, Volume 9, 2021, tkab040, https://doi.org/10.1093/burnst/tkab040
Renqi Yao, Yibing Zhu, Yue Yu, 等. Combination therapy of thiamine, vitamin C and hydrocortisone in treating patients with sepsis and septic shock: a meta-analysis and trial sequential analysis[J]. Burns & Trauma, 2021,9(1). DOI： 10.1093/burnst/tkab040.

Renqi Yao, Yibing Zhu, Yue Yu, Zhixuan Li, Lixue Wang, Liyu Zheng, Jingyan Li, Huibin Huang, Guosheng Wu, Feng Zhu, Zhaofan Xia, Chao Ren, Yongming Yao, Combination therapy of thiamine, vitamin C and hydrocortisone in treating patients with sepsis and septic shock: a meta-analysis and trial sequential analysis, Burns & Trauma, Volume 9, 2021, tkab040, https://doi.org/10.1093/burnst/tkab040 DOI：

摘要

Abstract

BackgroundThe objective of this study was to evaluate the clinical efficacy of thiamine and vitamin C with or without hydrocortisone coadministration on the treatment of sepsis and septic shock.MethodsMEDLINE

EMBASE and CENTRAL databases were searched for randomized controlled trials (RCTs) that made a comparative study between the combination therapy of vitamin C and thiamine with or without hydrocortisone and the administration of placebo in patients with sepsis or septic shock. Two reviewers independently performed study selection

data extraction and quality assessment. Both short-term mortality and change in the sequential organ failure assessment (SOFA) score from baseline (delta SOFA) were set as the primary outcomes. Secondary endpoints included intensive care unit (ICU) mortality

new onset of acute kidney injury

total adverse events

ICU and hospital length of stay

duration of vasopressor usage and ventilator-free days. Meanwhile

trial sequential analysis was conducted for primary outcomes.ResultsEight RCTs with 1428 patients were included in the current study. The results showed no significant reduction of short-term mortality in sepsis and septic shock patients who received combination therapy of vitamin C and thiamine with or without hydrocortisone compared to those with placebo {risk ratio (RR)

1.02 [95% confidence interval (CI)

0.87 to 1.20]

p = 0.81

I2 = 0%; risk difference (RD)

0 [95% CI

−0.04 to 0.05]}. Nevertheless

the combination therapy was associated with significant reduction in SOFA score [mean difference (MD)

−0.63

(95% CI

−0.96 to −0.29

p < 0.001

I2 = 0%] and vasopressors duration (MD

−22.11 [95% CI

−30.46 to −13.77]

p < 0.001

I2 = 6%). Additionally

there were no statistical differences in the pooled estimate for other outcomes.ConclusionsIn the current meta-analysis

the combination therapy of vitamin C and thiamine

with or without hydrocortisone had no impact on short-term mortality when compared with placebo

but was associated with significant reduction in SOFA score among patients with sepsis and septic shock.

关键词

Keywords

ThiamineVitamin CSepsisSeptic shockSequential organ failure assessmentMeta-analysis

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