Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients With Sepsis: The VICTAS Randomized Clinical Trial

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Main idea: Among critically ill patients with sepsis treatment with vitamin C, thiamine, and hydrocortisone, compared with placebo, did not significantly increase ventilator- and vasopressor-free days within 30 days.

Abstract

Sepsis is a common syndrome with substantial morbidity and mortality. A combination of vitamin C, thiamine, and corticosteroids has been proposed as a potential treatment for patients with sepsis.

The objective of the study was to determine whether a combination of vitamin C, thiamine, and hydrocortisone taken every 6 hours increases ventilator- and vasopressor-free days compared with placebo in patients with sepsis.

Participants of the study were randomized to receive intravenous vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) every 6 hours (n = 252) or matching placebo (n = 249) for 96 hours or until discharge from the intensive care unit or death. Participants could be treated with open-label corticosteroids by the clinical team. Study hydrocortisone or matching placebo was withheld if the total daily dose was greater than or equal to the equivalent of 200 mg of hydrocortisone.

Among 501 randomized participants the median age was 62 years; 46% female; 30% Black. All participants completed the trial. Open-label corticosteroids were prescribed to 33% and 32% of the intervention and control groups, respectively. Ventilator- and vasopressor-free days were a median of 25 days in the intervention group and 26 days  in the placebo group, with a median difference of -1 days. Thirty-day mortality was 22% in the intervention group and 24% in the placebo group.

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