Effects of thiamine on vasopressor requirements in patients with septic shock: a prospective randomized controlled trial

Abstract

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 in each group. There was no difference in the primary outcome of vasopressor-free days within the 7-day period between the thiamine and placebo groups (mean: 4.9 days (1.9) vs. 4.0 days (2.7), p = 0.197, mean difference − 0.9, 95% CI (− 2.9 to 0.5)). However, the reductions in lactate (p = 0.024) and in the vasopressor dependency index (p = 0.02) at 24 h were greater among subjects who received thiamine repletion vs. the placebo. No statistically significant difference was observed in SOFA scores within 7 days, vasopressor dependency index within 4 days and 7 days, or 28-day mortality. Conclusions Thiamine was not associated to a significant reduction in vasopressor-free days over 7-days in comparison to placebo in patients with septic shock. Administration of thiamine could be associated with a reduction in vasopressor dependency index and lactate level within 24 h. The study is limited by early stopping and low sample size. Trial registration TCTR, TCTR20180310001. Registered 8 March 2018, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=3330.

Effect of adjunctive vitamin C, glucocorticoids, and vitamin B1 on longer-term mortality in adults with sepsis or septic shock: a systematic review and a component network meta-analysis

“…The median of the follow-up periods was 28 days post randomization. The overall risk of bias was adjudicated to be low in 11 trials (34%) [ 3 , 7 , 9 , 30 , 32 , 35 , 39 – 41 , 44 , 49 ], moderate in eight trials (25%) [ 1 , 2 , 4 , 10 , 31 , 33 , 36 , 38 , 43 ], and high in 15 trials (41%) [ 13 , 28 , 34 , 37 , 42 , 49 – 48 , 50 – 55 ].…”

The Efficacy of vitamin C, thiamine, and corticosteroid therapy in adult sepsis patients: a systematic review and meta-analysis

“…Ascorbic acid plays a role in the increased production of endogenous catecholamines, leading to improved microvascular function in septic patients [ 9 , 16 , 29 , 47 ]. Thiamine aids in the aerobic metabolism of cells and may improve microvascular function and prevent organ failure [ 47 , 16 , 29 , 59 ]. In contrast, hydrocortisone may play a role in the potentiation of catecholamines, the mitigation of inflammation, and the prevention of vascular smooth muscle relaxation [ 45 ].…”

Delirium in Critical Illness Patients and the Potential Role of Thiamine Therapy in Prevention and Treatment: Findings from a Scoping Review with Implications for Evidence-Based Practice

“…It plays an important role in the Krebs cycle, and the pentose phosphate pathway. It is involved in the production of ATP as well as NADPH [55]. Due to its water-soluble nature, thiamine cannot be stored.…”