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Metabolic Resuscitation Might Not Decrease Longer-Term Mortality in sepsis: Study
Multiple studies have shown the value of steroids in sepsis and septic shock in terms of hastening the shock reversal. However, a recent study suggests that metabolic resuscitation with vitamin C, glucocorticoids, vitamin B1, or combinations of these drugs was not proven to decrease longer-term mortality. The study findings were published in the journal Intensive Care Medicine on November 09, 2021.
Recently, there has been considerable interest in "metabolic resuscitation" as adjunctive therapy for sepsis and septic shock. Such metabolic resuscitation has generally involved a combination of vitamin C, glucocorticoids, and vitamin B1 or one of its components. Dr Tomoko Fujii and his team conducted a study to compare the effects of vitamin C, glucocorticoids, vitamin B1, combinations of these drugs, and placebo or usual care on longer-term mortality in adults with sepsis or septic shock.
They conducted a random-effects network meta-analysis and, where applicable, a random-effects component network meta-analysis. They searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov and WHO-ICTRP for randomized controlled trials (RCTs) comparing very-high-dose vitamin C (≥ 12 g/day), high-dose vitamin C (< 12, ≥ 6 g/day), vitamin C (< 6 g/day), glucocorticoid (< 400 mg/day of hydrocortisone), vitamin B1, combinations of these drugs, and placebo/usual care. They included a total of forty-three RCTs with 10,257 patients. They used the Confidence in Network Meta-Analysis framework to assess the degree of treatment effect certainty.
The major outcome assessed was longer-term mortality (90-days to 1-year). They also assessed the severity of organ dysfunction over 72 h, time to cessation of vasopressor therapy, and length of stay in the intensive care unit (ICU).
Key Findings of the Study were:
- Upon analysis, the researchers found no significant differences in longer-term mortality between treatments and placebo/usual care or between treatments (10 RCTs, 7,096 patients, moderate to very-low-certainty).
- They also found no evidence that vitamin C or B1 affect organ dysfunction or ICU length of stay.
- However, they noted that glucocorticoid to other treatments shortened the duration of vasopressor therapy (incremental mean difference, − 29.8 h) and ICU stay (incremental mean difference, − 1.3 days).
The authors concluded, "Metabolic resuscitation with vitamin C, glucocorticoids, vitamin B1, or combinations of these drugs was not significantly associated with a decrease in longer-term mortality."
For further information:
DOI https://doi.org/10.1007/s00134-021-06558-0
Dr Kartikeya Kohli is an Internal Medicine Consultant at Sitaram Bhartia Hospital in Delhi with super speciality training in Nephrology. He has worked with various eminent hospitals like Indraprastha Apollo Hospital, Sir Gangaram Hospital. He holds an MBBS from Kasturba Medical College Manipal, DNB Internal Medicine, Post Graduate Diploma in Clinical Research and Business Development, Fellow DNB Nephrology, MRCP and ECFMG Certification. He has been closely associated with India Medical Association South Delhi Branch and Delhi Medical Association and has been organising continuing medical education programs on their behalf from time to time. Further he has been contributing medical articles for their newsletters as well. He is also associated with electronic media and TV for conduction and presentation of health programs. He has been associated with Medical Dialogues for last 3 years and contributing articles on regular basis.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751