Evaluation of thiamine as adjunctive therapy in COVID-19 critically ill patients: a two-center propensity score matched study (original) (raw)
Related papers
The Effect of Thiamine Supplementation for Critically Septic Patient: An Evidence-Based Case Report
2021
Sepsis has been accounted for various burdens worldwide, especially in critically ill patients. This could eventually lead to inflammatory response, provocation ischemia, and lactic acidosis. Several studies showed that thiamine deficiency is found in septic patients, with prevalence 20–70% in septic shock. Of these studies, thiamine deficiency could worsen patient’s outcome. On the other hand, thiamine was suggested as a coenzyme which could improve the outcome of those patients. Unfortunately, the role of thiamine supplementation in septic patients is not conclusive. Thus, we conducted an evidence-based case study with research on PubMed, ProQuest, and Scopus using a search strategy focusing on randomized controlled trial (RCT) or cohort study on thiamine supplementation/level towards the outcome of critically ill patients with sepsis. We found three articles eligible for review after full-text assessment. Articles were appraised using the University of Oxford’s tools for critical...
Is Thiamine Administration Effective in Sepsis or Not? A Randomized Controlled Trial
INTERNATIONAL JOURNAL OF MEDICAL SCIENCE AND CLINICAL RESEARCH STUDIES, 2022
Background: Sepsis is the first leading cause of death in Myanmar and complications are also difficult to solve. This study aimed to detect the effect of thiamine on lactate clearance and mortality in patients with sepsis. Method: A randomized controlled trial done in No.(1) Defence Services General Hospital, Yangon from October 2020 to June 2022. All patients > 18 years old admitted with suspected or documented infection and qSOFA score 2 or 3 were included but alcohol related cases were excluded. Total 80 patients were assigned 1:1 by block randomization. Intervention group was given IV thiamine 100 mg 6 hourly for 3 days. Primary outcome was lactate clearance and secondary outcomes, mSOFA score (both were assessed in day 1, day 3 and day 7), and mortality within 7 days. Intention to treat analysis with worst data imputation in missing value for expired cases. Results: Significant lactate clearance was seen in intervention group compared with control group, in day 3, [23.53% (34.37) vs 16.67% (43.30), z =-2.353, p = 0.019] and day 7, [53.85% (28.90) vs 30.22% (38.61), z =-3.186, p = 0.001]. Lactate clearance over time was well observed in the intervention group, [X 2 (2) = 29.356, p < 0.001] but not in the control group, [X 2 (2) = 3.152, p = 0.207]. Significant mSOFA score reduction over time was also observed in the intervention group, [X 2 (3) = 39.330, p < 0.001]. All-cause mortality within 7 days was not different, [X 2 (1) = 0.949, p = 0.330, OR 0.949, 95% CI (0.51-7.12)]. Conclusion: Thiamine supplementation in sepsis patient was benefit in lactate clearance starting from day 3 and reduction of mSOFA score starting from day 7. But it did not show the mortality benefit within 7 days period.
Thiamine for Septic Shock: Clinical Outcomes and Updates (Atena Editora)
Thiamine for Septic Shock: Clinical Outcomes and Updates (Atena Editora), 2024
Objective: To examine the effectiveness of thiamine in improving clinical outcomes of patients with septic shock, including mortality, length of hospital stays, and need for organ support, and to update clinical guidelines based on the latest evidence. Methods: Literature review developed according to the criteria of the PVO strategy through its guiding question: “How does thiamine supplementation influence the clinical outcomes of patients with septic shock?”. The searches were carried out using the PubMed database using the search strategy: (septic shock) OR (sepsis) AND (thiamine). Immediately after applying the inclusion and exclusion criteria, 16 articles were selected to form the collection of this study. Review: The use of thiamine for septic shock is discussed, analyzing the effectiveness of this treatment in improving clinical outcomes in critically ill patients. Although initial studies suggest benefits, such as maintaining adequate blood pH and preserving cardiac and neurological function, studies in humans have shown inconsistent results, especially in relation to reduced mortality. Thiamine showed potential in eliminating lactate and controlling oxidative stress, suggesting a therapeutic role in specific cases. More rigorous studies are still needed to confirm these benefits, given the variability of the results observed. Final considerations: The results indicate that thiamine can improve some metabolic parameters and reduce mortality in certain cases, but the evidence is inconsistent, requiring further studies. The safety profile of thiamine is good and has therapeutic potential, but its effectiveness varies depending on the patient's metabolic status and the presence of thiamine deficiency. Future research must focus on identifying which patients benefit most from its use and optimizing dosages and administration methods.
Journal of Intensive Care, 2022
Background Although the effect of thiamine alone or in combination with vitamin C has been studied in multiple trials (RCT and interventional studies), their results are inconsistent. This meta-analysis aimed to assess impact of thiamine administration alone, thiamine in combination with vitamin C, and co-administration of low-dose hydrocortisone, vitamin C and thiamine (HVT) on clinical outcomes in critically ill patients. Methods and materials After electronic searches on PubMed, Scopus, Cochrane Library, and Web of Science databases, initially 3367 papers were found, and 20 interventional studies were included in our analysis. We assessed the risk-difference between treatment and control (standard treatment) groups by pooling available data on ICU length of stay, number of ventilator free days, mortality, and changes in Sequential Organ Failure Assessment (SOFA) scores. Results The results of present studies revealed no significant effect of thiamine in combination with vitamin C...
Thiamine deficiency in critically ill patients with sepsis
Journal of Critical Care, 2010
Objective: The objective of the study was to determine the prevalence of absolute thiamine deficiency (TD) in critically ill patients with sepsis and to examine the association between thiamine levels and lactic acidosis. Design: This was a prospective, observational study. Setting: The setting was an urban, tertiary care center with approximately 50 000 emergency department visits per year and intensive care units numbering approximately 50 total beds. Patients: Thirty study patients admitted with clinical suspicion of infection and evidence of tissue hypoperfusion, as defined by a lactic acid level greater than 4 mmol/L or hypotension (systolic blood pressure b90 mm Hg) requiring vasopressor support, were enrolled. A control group of 30 patients presenting to the emergency department with minor emergencies was also enrolled.
Encephalopathy responsive to thiamine in severe COVID-19 patients
Brain, Behavior, & Immunity - Health, 2021
Encephalopathy is one of the most frequent neurological complications of severe Coronavirus Disease 2019 (COVID-19) patients. Cytokine storm and sepsis, hypercatabolic states, the use of furosemide and dialytic therapy represent risk factors for thiamine deficiency and are also found in patients with severe COVID-19. In this retrospective case series, we report clinical and neurological findings of fifteen patients with COVID-19-associated Wernicke Encephalopathy (WE) and their response to treatment with intravenous thiamine. All patients had encephalopathy, with 67% displaying at least one additional sign of classic WE triad (ophthalmoparesis and ataxia). Two patients (13%) had the classic triad. All COVID-19 patients had significant improvement of the neurological manifestations between two to five days after intravenous thiamine administration. Eleven patients (73%) had good neurological outcome at hospital discharge and only two patients (13%) died. This case series suggests that thiamine deficiency may be an etiology of encephalopathy in severe COVID-19 patients and its treatment may represent a safety and low-cost response to reduce the neurological burden.
BMC Anesthesiology
Background Thiamine, an essential vitamin for aerobic metabolism and glutathione cycling, may decrease the effects of critical illnesses. The objective of this study was to determine whether intravenous thiamine administration can reduce vasopressor requirements in patients with septic shock. Methods This study was a prospective randomized double-blind placebo-controlled trial. We included adult patients with septic shock who required a vasopressor within 1–24 h after admission between March 2018 and January 2019 at a tertiary hospital in Thailand. Patients were divided into two groups: those who received 200 mg thiamine or those receiving a placebo every 12 h for 7 days or until hospital discharge. The primary outcome was the number of vasopressor-free days over 7 days. The pre-defined sample size was 31 patients per group, and the study was terminated early due to difficult recruitment. Results Sixty-two patients were screened and 50 patients were finally enrolled in the study, 25...
Annals of the American Thoracic Society, 2014
Rationale: Oxygen consumption may be impaired in critically ill patients. Objectives: To evaluate the effect of intravenous thiamine on oxygen consumption (V : O 2) in critically ill patients. Methods: This was a small, exploratory open-label pilot study conducted in the intensive care units at a tertiary care medical center. Critically ill adults requiring mechanical ventilation were screened for enrollment. Oxygen consumption (V : O 2) and cardiac index (CI) were recorded continuously for 9 hours. After 3 hours of baseline data collection, 200 mg of intravenous thiamine was administered. The outcome was change in V : O 2 after thiamine administration. Measurements and Main Results: Twenty patients were enrolled and 3 were excluded because of incomplete V : O 2 data, leaving 17 patients for analysis. There was a trend toward increase in V : O 2 after thiamine administration (16.3 ml/min, SE 8.5; P = 0.052). After preplanned adjustment for changes in CI in case of a delivery-dependent state in some patients (with exclusion of one additional patient because of missing CI data), this became statistically significant (16.9 ml/min, SE 8.6; P = 0.047). In patients with average CI greater than our cohort's mean value of 3 L/min/m 2 , V : O 2 increased by 70.9 ml/min (616; P , 0.0001) after thiamine. Thiamine had no effect in patients with reduced CI (, 2.4 L/min/m 2). There was no association between initial thiamine level and change in V : O 2 after thiamine administration. Conclusions: The administration of a single dose of thiamine was associated with a trend toward increase in V : O 2 in critically ill patients. There was a significant increase in V : O 2 in those patients with preserved or elevated CI. Further study is needed to better characterize the role of thiamine in oxygen extraction. Clinical trial registered with www.clinicaltrials.gov (NCT01462279).
Vitamin C and thiamine are associated with lower mortality in sepsis
Journal of Trauma and Acute Care Surgery, 2020
BACKGROUND: The efficacy of vitamin C (VitC) and thiamine (THMN) in patients admitted to the intensive care unit (ICU) with sepsis is unclear. The purpose of this study was to evaluate the effect of VitC and THMN on mortality and lactate clearance in ICU patients. We hypothesized that survival and lactate clearance would be improved when treated with thiamine and/or VitC. METHODS: The Philips eICU database version 2.0 was queried for patients admitted to the ICU in 2014 to 2015 for 48 hours or longer and patients with sepsis and an elevated lactate of 2.0 mmol/L or greater. Subjects were categorized according to the receipt of VitC, THMN, both, or neither. The primary outcome was in-hospital mortality. Secondary outcome was lactate clearance defined as lactate less than 2.0 mmol/L achieved after maximum lactate. Univariable comparisons included age, sex, race, Acute Physiology Score III, Acute Physiology and Chronic Health Evaluation (APACHE) IVa score, Sequential Organ Failure Assessment, surgical ICU admission status, intubation status, hospital region, liver disease, vasopressors, steroids, VitC and THMN orders. Kaplan-Meier curves, logistic regression, propensity score matching, and competing risks modeling were constructed. RESULTS: Of 146,687 patients from 186 hospitals, 7.7% (n = 11,330) were included. Overall mortality was 25.9% (n = 2,930). Evidence in favor of an association between VitC and/or THMN administration, and survival was found on log rank test (all p < 0.001). After controlling for confounding factors, VitC (adjusted odds ratio [AOR], 0.69 [0.50-0.95]) and THMN (AOR, 0.71 [0.55-0.93]) were independently associated with survival and THMN was associated with lactate clearance (AOR, 1.50 [1.22-1.96]). On competing risk model VitC (AOR, 0.675 [0.463-0.983]), THMN (AOR, 0.744 [0.569-0.974]), and VitC+THMN (AOR, 0.335 [0.13-0.865]) were associated with survival but not lactate clearance. For subgroup analysis of patients on vasopressors, VitC+THMN were associated with lactate clearance (AOR, 1.85 [1.05-3.24]) and survival (AOR, 0.223 [0.0678-0.735]). CONCLUSION: VitC+THMN is associated with increased survival in septic ICU patients. Randomized, multicenter trials are needed to better understand their effects on outcomes.