Therapeutic Role of HAT Therapy in Sepsis: A Systematic Review and Meta-Analysis-Reference-Cited by-同舟云学术

Therapeutic Role of HAT Therapy in Sepsis: A Systematic Review and Meta-Analysis

Published:2024-01-22 Issue: Volume:31 Page:
ISSN:0929-8673
Container-title:Current Medicinal Chemistry
language:en
Short-container-title:CMC

Author:

Saghafi Fatemeh¹,Boostani Moghadam Zahra²,Salehi-Abargouei Amin³⁴,Beigrezaei Sara³,Sohrevardi Seyed Mojtaba¹⁵,Jamialahmadi Tannaz⁶,Sahebnasagh Adeleh⁷,Sahebkar Amirhossein⁸⁹

Affiliation:

1. Department of Clinical Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2. Pharmaceutical Sciences Research Center, School of Pharmacy, Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3. Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

4. Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

5. Stroke Prevention & Atherosclerosis Research Centre, University of Western Ontario, Canada

6. International UNESCO center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran

7. Clinical Research Center, Department of Internal Medicine, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran

8. Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran

9. Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: This systematic review and meta-analysis aimed to determine whether the combination of hydrocortisone, vitamin C (ascorbic acid), and thiamine (HAT therapy) diminishes the mortality and is effective in expediting the resolution of sepsis and septic shock or not. Methods: The following databases of PubMed, Scopus, ISI Web of Science, and Google Scholar were explored until March 2021 for all existing literature related to this field. An automatic alert for all databases was also activated to update our search. Meta-analysis was performed on clinical trials and cohorts separately as well as on all the pooled populations. Results: This study evaluated nine clinical trials (1358 participants) and nine cohorts (339,437 participants) and is the most comprehensive systematic review in this field. The results of our meta-analysis demonstrated a significant difference in the reduction of Sepsis-Related Organ Failure Assessment (SOFA) score changes (Δ-SOFA) over 72 h (Standard Mean Difference (SMD) = −0.429; 95% CI: −0.737, 0.120; P = 0.006), duration of vasopressor (VP) (SMD = −0.373; 95% CI: −0.619, −0.128; P = 0.003), and procalcitonin (PCT) clearance (SMD = 0.496; 95% CI: 0.061, 0.931%; P = 0.026). Considering the results of cohorts, HAT therapy was effective in the survival of intensive care units (ICUs) patients (OR = 0.641; 95% CI: 0.423-0.970, P = 0.035). However, no significant difference was observed between the intervention and control groups in hospital mortality (Odds Ratio (OR) = 0.811, 95% CI: 0.544-1.209, P = 0.304), 28- to 30-day mortality (OR = 1.000; 95% CI: 0.782-1.279, P = 0.998), new onset acute kidney injury requiring renal replacement therapy ((OR = 0.856, 95% CI: 0.526, 1.391; P = 0.529), in-hospital length of stay (LOS) (SMD = 0.090; 95% CI: −0.036, 0.216 days; P = 0.162), LOS in ICU (SMD = 0.016, 95% CI: −0.138, 0.170 days; P = 0.838), and mechanical ventilation-free days (SMD = 0.004; 95% CI: −0.154, 0.163 days; P = 0.956). Conclusion: Supplementation of septic and septic shock patients with HAT therapy has significant beneficial effects on SOFA score over 72 hours, duration of exogenous vasopressor infusion and procalcitonin clearance. Considering the results of cohort studies, supplementation with HAT is efficacious in reducing ICU mortality.

Publisher

Bentham Science Publishers Ltd.