Thiamine not associated with improved mortality in septic shock

In a retrospective observational study of more than 68,000 patients in Japan, the 28-day mortality rate was 19.2% in those who received thiamine soon after hospital admission versus 17.8% in those who did not.

Patients who receive thiamine soon after admission for septic shock do not appear to have improved survival at 28 days, according to a recent study.

Researchers in Japan performed a retrospective observational cohort study at over 1,000 acute care hospitals to determine whether thiamine affected mortality in patients with septic shock who required norepinephrine within two days of admission. Data from July 2010 to March 2017 were analyzed. Patients were included in the thiamine group if they received at least 100 mg of thiamine within two days of admission. The primary outcome was 28-day mortality. Study results were published May 11 by Critical Care Medicine.

Overall, 68,571 patients were eligible for the study. Of these, 18,780 received thiamine within two days of admission and 49,791 did not. Among those receiving thiamine, 10,143 (54.0%) received 100 mg/d and 7,679 (40.9%) received 200 mg/d. Twenty-eight day mortality rates were 19.2% in the thiamine group and 17.8% in the no-thiamine group. The researchers adjusted for confounders by inverse probability of treatment weighting and found no significant differences between the thiamine and no-thiamine groups (risk difference, 0.2%; 95% CI, –0.5% to 0.9%), between the 100-mg thiamine group and the no-thiamine group (risk difference, 0.6%; 95% CI, –0.3% to 1.4%), or between the 200-mg thiamine group and the no-thiamine group (risk difference, –0.3%; 95% CI, –1.3% to 0.8%).

The researchers noted that their study was observational, that data on serum thiamine levels were not included, and that differences in norepinephrine doses could not be assessed. They concluded that their study indicated no benefit of early thiamine administration among patients with septic shock who required norepinephrine. However, they wrote, “Further studies are warranted to evaluate the efficacy of thiamine administration to patients with septic shock, especially using doses higher than those used in our cohort.”

A story in the May ACP Hospitalist covers the debate about use of vitamin C, alone or in combination with thiamine and hydrocortisone, for sepsis care.