The correlation of blood thiamine concentrations with lactate acidosis in peritonitis patients with sepsis

Abstract

Background: Vitamin B1 (Thiamine) functions as a pyruvate dehydrogenase cofactor to produce acetyl Co-A and activate the Krebs cycle in cellular metabolism. The hypermetabolic state in septic condition requires excess thiamin to keep the Krebs cycle functioning well. The thiamin level in the blood decreases and causes mitochondrial dysfunction and vice versa results in an increase in lactate levels. This study aims to evaluate the correlation of blood thiamine concentrations with lactate acidosis in peritonitis patients with sepsisMethods: Prospective observational study in 65 adult septic patients who came to the hospital with peritonitis and underwent laparotomy. Thiamine concentration was assessed on days 1, 3, and 5 by liquid chromatography-mass spectrometry (LC-MS). The primary outcome was lactate levels. Data was analyzed using SPSS version 23 for Windows.Results: The incidence of thiamine deficiency (TD) was 61.5% of patients. Specifically, 29 cases (44.6%) had absolute thiamine deficiency (TD) on presentation, 4 patients (6.1%) developed it on day 3, and another 7 patients (10.8%) on day 5. Thiamine was negatively correlated with lactate levels (r=-0.600; p=0.020). The relationship appeared after multivariable regression analysis controlling for sex, septic shock, and malnutrition. Overall, for the TD group, there was a significant association with septic shock, malnourishment, and Mortality (p<0.05). Conclusion: Thiamine deficiency had significantly raised lactate levels, which might increase the risk of Mortality.

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“…According to Figure 2, the graph is consistent with research that states that empirical antimicrobial therapy for sepsis and septic shock should have a broad spectrum from the start to maximize the range of potential microorganisms that are considered responsible for the underlying infection [5].…”

“…Empiric antibiotics should be broadspectrum covering all possible pathogens. Selection of empiric antibiotics should consider the site of infection, previous use of antibiotics, local pathogen susceptibility patterns, immunosuppression, and risk factors for resistant organisms [5]. Empirical antimicrobial therapy should be tapered after identification of the pathogen and susceptibility is obtained, or discontinued if the decision is made that the patient does not have infection.…”