The effects of thiamine on patients with sepsis and septic shock

Abstract

Background: There is growing evidence that thiamine alone or in combination with vitamin C and steroids may have benefits in patients with sepsis. The purpose of this study is to evaluate the effects of intravenous thiamine following creation of an institutional thiamine guideline for sepsis. Methods: In this biphasic IRB-approved study, the pre-intervention group consisted of patients 18 years or older admitted to a critical care unit with sepsis/septic shock who received intravenous thiamine plus standard care (n=26). In the retrospective phase, they were matched with patients with the same diagnosis who served as a control group (n=26). The primary endpoint was hospital mortality. Secondary endpoints were time to death, critical care length of stay, time to lactate level <2 mmol/L, vasopressor use and duration, renal replacement therapy (RRT) requirement, and PaO 2 /FiO 2 ratio. An evidence-based thiamine guideline for sepsis, standardizing the dose, duration, and time of initiation, was developed and implemented. In the prospective phase, the post-intervention thiamine group was compared with both the pre-intervention thiamine and control groups measuring the same endpoints. Results: In the pre- and post-intervention phase, there was no difference in hospital mortality. However, more patients in the control group required RRT as compared to pre-intervention thiamine group (65.4% vs. 42.3%, P=0.013). The post-intervention thiamine group also showed decreased RRT requirement compared to the control group (36.8% vs. 65.4%, P=0.02). Conclusions: Thiamine did not show hospital mortality benefit. However, it may be considered for use in patients with renal dysfunction. Future studies should further explore renally-protective effects of thiamine.