Hydrocortisone, Ascorbic Acid, Thiamine Combination Beneficial in Paediatric Septic Shock: Presented at SCCM

By Nancy Melville

ORLANDO, Fla -- February 20, 2020 -- The use of an intravenous combination of hydrocortisone, ascorbic acid, and thiamine (HAT) as adjunctive therapy in the treatment of children with septic shock significantly reduces mortality, according to research presented here at the 2020 Annual Meeting of the Society of Critical Care Medicine (SCCM).

“Our results suggest that hydrocortisone, ascorbic acid, and thiamine therapy, when administered early in the clinical course, reduces mortality in children with septic shock,” stated Eric L. Wald, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, and colleagues.

Interest in HAT therapy for septic shock treatment was raised when previous research showed dramatically lower mortality rates with the adjunctive treatment among adult patients with septic shock; however, some studies failed to show benefit with the combination therapy. Furthermore, no studies reported on the effect of the potentially safe and low-cost intervention among children with septic shock.

To evaluate the issue, the researchers identified 557 patients meeting septic shock criteria at a large academic paediatric intensive care unit between January 2014 and February 2019.

Of the patients, 43 were treated with HAT therapy, which was introduced at the centre in 2017. These patients were matched 1:1:1 in a propensity analysis to compare those with balanced characteristics among patients who received hydrocortisone therapy alone and controls who were untreated.

Patients treated with HAT therapy had significantly lower mortality rates than controls at 30 days (9% vs 28%; P = .03) and 90 days (14% vs 35%; P = .02). Mortality rates were also lower in patients who received HAT therapy than in those who received hydrocortisone alone at 30 days (9% vs 28%; P = .03) and 90 days (14% vs 33%; P = .04).

At 30 days, no differences were seen in the number of vasoactive inotrope-free or hospital-free days among any of the comparison groups.

“We were surprised and excited to see a substantial reduction in mortality after treating septic shock in children with a high dose of vitamin C combined with vitamin B1 and hydrocortisone,” said Dr. Wald.

“While based on a retrospective analysis, our results are especially compelling in that they are very similar to the positive outcomes found in a recent randomised controlled trial of vitamin C treatment for septic shock in adults,” he added.

Dr. Wald noted that larger studies are needed to better understand the mechanisms behind the potential benefits of the combination therapy.

“While it is still unclear why vitamin C appears to reduce mortality from septic shock, and we need to dig deeper to understand the mechanism, our results are incredibly promising,” Dr. Wald concluded. “We hope to encourage larger, multicentre studies in children with septic shock to confirm our data.”

[Presentation title: Hydrocortisone/Ascorbic Acid/Thiamine Use Associated With Lower Mortality in Pediatric Septic Shock. Abstract 25]

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