BACKGROUND Sepsis and septic shock are medical emergencies resulting in significant morbidity and mortality. Intravenous (IV) vitamin C, thiamine, and hydrocortisone have shown promise in reducing hospital mortality. The Memphis Veterans Affairs Medical Center (VAMC) similarly implemented this regimen, called the vitamin C protocol, for patients presenting in sepsis or septic shock in the intensive care unit (ICU). METHODS This retrospective study in Veteran ICU patients with sepsis or septic shock compared outcomes of patients treated with IV vitamin C, thiamine, and hydrocortisone (treatment) with those who received IV hydrocortisone alone (control). Data was propensity matched to ensure comparability at baseline. The Sequential Organ Failure Assessment (SOFA) score was calculated at day of diagnosis (day 0) and daily for 3 subsequent days. At the 24-month follow-up, 12 months after the 1-year-intervention, survival and measures of mental and physical health were collected by telephone interviews. RESULTS Hospital mortality, the primary outcome, did not differ significantly between groups. Secondary outcomes including ICU, 28-day, and 60-day mortality were also not different, nor were vasopressor duration or hospital length of stay. However, ICU length of stay was significantly reduced in the treatment group compared to control (7.1 vs 15.6 days, respectively, P = 0.04). CONCLUSIONS Although no significant mortality benefit was observed, the vitamin C protocol was not associated with patient harm. In this Veteran population, there was reduced ICU length of stay, suggesting possible benefit. Though further investigation is warranted, utilization of IV vitamin C, thiamine, and hydrocortisone in patients with sepsis or septic shock may be a treatment option worth considering.

中文翻译：

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维生素C和硫胺素可用于败血症和败血性休克。

背景技术败血症和败血性休克是医学紧急事件，导致明显的发病率和死亡率。静脉（IV）维生素C，硫胺素和氢化可的松已显示出降低医院死亡率的希望。孟菲斯退伍军人事务医疗中心（VAMC）同样为重症监护病房（ICU）中出现败血症或脓毒性休克的患者实施了称为维生素C方案的方案。方法这项回顾性研究在败血症或败血性休克经验丰富的ICU患者中比较了接受IV维生素C，硫胺素和氢化可的松（治疗）与仅接受IV氢化可的松（对照）治疗的患者的结局。对数据进行倾向性匹配，以确保基线的可比性。在诊断日（第0天）和随后的3天内每天计算顺序器官衰竭评估（SOFA）分数。在为期一年的干预后的12个月，即24个月的随访中，通过电话采访收集了患者的生存和心理健康状况。结果两组的主要结果是医院死亡率。包括ICU，28天和60天死亡率在内的次要结局也没有差异，升压药的持续时间或住院时间也没有变化。但是，与对照组相比，治疗组的ICU住院时间明显缩短（分别为7.1天和15.6天，P = 0.04）。结论尽管未观察到明显的死亡率益处，但维生素C方案与患者伤害无关。在这个退伍军人人群中，ICU住院时间缩短了，表明可能会受益。尽管有必要进行进一步研究，但还是要使用IV维生素C，硫胺素，