Impact of thiamine supplementation on mortality in septic shock: a retrospective before-after study

Abstract

Background Sepsis and septic shock represent major challenges in terms of patient mortality. Despite numerous studies involving various drugs and interventions, effective results have not been demonstrated. Recently, the role of thiamine in critically ill patients has gained attention. In this study, we aimed to assess the impact of supplemental thiamine on clinical outcomes in patients with septic shock. Methods This retrospective before-after study included patients with: 1) an age ≥ 18 years with documented or suspected infection; 2) Sequential Organ Failure Assessment score ≥ 2; 3) serum lactate levels > 18 mg/dL and hypotension, 4) mean arterial pressure < 65 mm Hg maintained after volume expansion of ≥ 30 ml/kg in the first 2 h of treatment followed by noradrenaline vasopressor dependence (with or without vasopressin) during the first 6 h of treatment; 5) intensive care unit (ICU) admission during two periods: May 1 to September 30, 2022 (control group) and November 1, 2022 to March 31, 2023 (intervention group). Only the intervention group received supplemental thiamine (200 mg in 50 ml 5% dextrose twice daily) for 7 days or until ICU discharge. The primary outcome was 28-day mortality. The secondary outcomes were lactate clearance, ventilation-free and vasopressor-free days within 28 days, and incidence of renal replacement therapy (RRT) within 2 d of septic shock diagnosis. Results Sixty-two patients were included, 29 in the control group and 33 in the intervention group. There was no difference in 28-day mortality between the intervention and control group (n = 18, 54.5% vs. n = 19, 65%, p = 0.63). There was no difference in secondary outcomes Nine patients (27.2%) in the intervention group were administered RRT compared to three (10.3%) in the control group (p = 0.09). However, after adjusting for independent covariates, multivariate analysis showed that age (p = 0.017), lactate clearance (p = 0.044), and vasopressor-free days (p = 0.043) were associated with a lower 28-day mortality. Conclusions In the clinical setting, patients with septic shock may not benefit from intravenous thiamine in terms of 28-day mortality. however, older patients, those with longer vasopressor dependence, and those with poor lactate clearance may be at a higher risk of 28-day mortality. Trial registration: www.clinical trials.gov [NCT05840718, (03/05/2023)]