Vitamin C for #sepsis

Marik et al: Retrospective before–after study (2017): n 47

Hydrocortisone, Vit C & thiamine vs controls:
* Hosp mortality: 8.5% vs 40.4%
* SOFA decreased with none in Vit C group developing organ failure

How has data panned out since?

#CHESTCritCare

CITRIS-ALI RCT @JAMANetwork 2019:

In sepsis + ARDS, IV Vit C (n 84) vs placebo (n 83):

No difference in mod SOFA at 96 hours or CRP/thrombomodulin levels at 168 hours.

#CHESTCritCare

VITAMINS RCT @JAMANetwork 2020:

IV Vit C, hydrocortisone & thiamine (n 109) vs hydrocortisone (n 107) alone in #Sepsis

No difference in primary outcome: duration of time alive AND free of vasopressor administration over 7 days (122.1 hours vs 124.6 hours)

#CHESTCritCare

HYVCTTSSS RCT in #journalCHEST 2020

https://pubmed.ncbi.nlm.nih.gov/32243943/ 

IV Vit C, hydrocortisone & thiamine vs placebo in #Sepsis (n 40 each)

No difference in 28-day all-cause mortality was observed (27.5% vs 35%)

#CHESTCritCare

ORANGES RCT in #journalCHEST 2020:

Vit C, hydrocortisone & thiamine (n 68) vs control (n 69) in #Sepsis and Septic shock

* Quicker reversal of shock in Rx group (27 +/-
22 vs 53 +/- 38 hours, P < .001)
* No diff in SOFA score, ICU/hospital mortality/LOS, ventilator free days

ACTS RCT @JAMANetwork 2020:

Vit C, hydrocortisone & thiamine Q 6 hours (n 103) vs placebo (n 102) x 4 days in matching volumes at the same time points.

No statistically significant reduction in SOFA score during the first 72 hours after enrollment.

Note the adverse effects:

ATESS RCT (ICM 2020):

Vit C & thiamine (n 53) vs placebo (n 58) in #SepticShock:

No significant difference in ΔSOFA scores after 72 hours.

#CHESTCritCare

Take a look at this informative thread by @nickmmark summarizing this data as well:

https://twitter.com/nickmmark/status/1295857244098027521?s=20

TL;DR: ORANGES are not the new ANTIBIOTICS.

Let us know your thoughts!