Authors:
A small provocative study suggests a mortality benefit. The metabolic demands of septic shock commonly lead to thiamine deficiency, and thiamine has therefore received attention as an adjunctive therapy for septic shock. In a retrospective single-center cohort study, investigators assessed outcomes in patients in septic shock who received thiamine compared with those who did not. Patients were identified using ICD codes and chart review to ensure they met Sepsis-3 definitions (lactate >2.0 mmol/L plus vasopressor therapy) at hospital admission. Among 1049 eligible patients, 123 received thiamine and were matched using demographics and measures of disease severity with 246 patients who did not receive thiamine. The main outcome was time to first documentation of lactate clearance; 28-day mortality was among several prespecified secondary outcomes. The most common protocol for thiamine administration at this center was a high dose (500 mg) every 8 hours for 72 hours. The study patients were quite ill, with a median day-1 Sequential Organ Failure Assessment (SOFA) score of 10, and median peak lactate of 6 mmol/L; nearly two thirds had liver disease. Lactate clearance was significantly improved in thiamine recipients compared with nonrecipients (hazard ratio, 1.3), and in a multivariable model adjusting for clinical factors, 28-day mortality was significantly decreased (HR, 0.67). Both effects were more pronounced in women. None of the other secondary outcomes differed significantly between groups. |
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COMMENT
Although the absence of a protocol to measure repeat lactate muddies the interpretation of the main outcome of this study, a significant decrease in mortality, if validated, would be important. Because the lack of randomization leaves open the possibility of unmeasured confounding, this small retrospective study is not enough to change practice; however, it seems like more than enough to prompt further investigation.