Adding vitamin C to hydrocortisone lacks benefit in septic shock: a historical cohort study

• Published in: Canadian journal of anesthesia Vol. 67; no. 12; pp. 1798 - 1805
• Main Authors: Chang, Kimberley, Harbin, Megan, Shuster, Constantin, Griesdale, Donald E. G., Foster, Denise, Sweet, David, Wood, Michael D., Dhingra, Vinay K.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2020; Springer Nature B.V
• Subjects: Anesthesiology; Ascorbic Acid - therapeutic use; Cardiology; Cohort analysis; Cohort Studies; Critical Care Medicine; Female; Hospital Mortality; Humans; Hydrocortisone - therapeutic use; Intensive; Intensive Care Units; Male; Medicine; Medicine & Public Health; Mortality; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Reports of Original Investigations; Sepsis; Shock, Septic - drug therapy; Steroids; Vitamin C; Vitamins; critical care; septic shock; ICU; corticosteroids; vitamin C
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-020-01814-1

Purpose Sepsis has high incidence and mortality rates, particularly in the intensive care unit (ICU). Corticosteroids may improve outcomes, and vitamin C may add benefit. We aimed to assess whether vitamin C and corticosteroids improved outcomes compared with corticosteroids alone. Methods This historical cohort study (11 December 2016 to 21 February 2018) was conducted in the ICU of a quaternary referral hospital. Patients with an ICU admission diagnosis of sepsis or septic shock who received vitamin C and hydrocortisone within 72 hr were compared with those who received only hydrocortisone. All patients received standard sepsis care including source control, antibiotics, and fluid resuscitation. Most patients received thiamine as standard ICU care. The primary outcome was hospital mortality. Secondary outcomes included ICU mortality, ventilator-free days, vasopressor-free days, dialysis use, and duration of ICU admission. Results One hundred and forty-four patients were included in the study. The mean (standard deviation [SD]) age was 64 (15) yr; 39% were female; and the mean (SD) Acute Physiology And Chronic Health Evaluation IV score was 89 (30). Eighty-eight patients did not receive vitamin C and 52 received vitamin C. There was no observed difference in hospital mortality between the non-vitamin C (36%) and vitamin C (39%) groups (adjusted odds ratio for hospital death, 0.52; 95% confidence interval, 0.20 to 1.34; P = 0.18). There were no statistically significant differences in any secondary outcomes. Conclusion In this small observational study of ICU patients with septic shock, the addition of vitamin C to hydrocortisone therapy did significantly affect hospital mortality or other measures of mortality or organ dysfunction.