CHEST Guidelines-Additional-Trials-of-Vitamin-C-in-Septic-Shock

Additional-Trials-of-Vitamin-C-in-Septic-Shock_che (1)

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The rising global prevalence of sepsis, which caused an estimated 11 million deaths in 2017, highlights the urgent need for effective and affordable treatments. Vitamin C combination therapy, including high doses of vitamin C, thiamine, and hydrocortisone, gained attention after a 2017 study suggested it might reduce mortality and vasopressor dependency in sepsis patients. This led to numerous randomized clinical trials (RCTs) exploring its efficacy.<br /><br />Two notable trials have provided mixed results. The HYVCTTSSS trial in China was stopped early due to severe hypernatremia in patients receiving the therapy, with no significant mortality benefit observed. Notably, it did show improved sepsis-related organ failure assessment (SOFA) scores, but without hydrocortisone use in the control group, its effects remain uncertain. The ORANGES trial in the United States found a shorter duration of vasopressor dependency with the therapy but no improvement in longer-term outcomes like mortality, ICU stay, or organ support requirements.<br /><br />The inconsistent results across trials, including varying effects on SOFA scores and vasopressor dependency, suggest confounding factors, particularly the uncontrolled use of hydrocortisone, may skew results. This underlines the importance of well-designed studies with transparent protocols and statistically valid comparisons.<br /><br />There is no clear evidence that vitamin C combination therapy significantly improves major outcomes for septic shock, such as mortality rates. Further research is ongoing, hoping to clarify its roles and implications in sepsis treatment. The variability in trial outcomes highlights the need to complement innovative therapies with established sepsis management practices like rapid resuscitation and prompt antibiotic use.

Keywords

sepsis

vitamin C therapy

thiamine

hydrocortisone

randomized clinical trials

mortality

vasopressor dependency

SOFA scores

septic shock

sepsis treatment