Journal Article

Association of Vitamin C, Thiamine, and Hydrocortisone Infusion With Long-term Cognitive, Psychological, and Functional Outcomes in Sepsis Survivors

Ely, E. Wesley, Nguyen, Kelly, Negrin, Lovie, Lindsell, Christopher J., Davidov, Ervin, Peltan, Ithan, Smithline, Howard, Kalin, Dan, Hinson, Jeremiah, Harris, Estelle S., Brown, Katie, Chang, Steven Y., Quinn, James, Kashyap, Rahul, Howell, Michelle, Wilson, Jennifer, Youngquist, Scott T., Moss, Marc, Nwosu, Samuel, Gong, Michelle, McBride, Mary, Ricketts, Erin, Ginde, Adit, Levitt, Joseph, Steingrub, Jay, Polito, Carmen, Brokowski, Carolyn, Greenwood, John C., Visweswaran, Anita, Sevransky, Jonathan E., Barksdale, Aaron, Lopez, Brenda, McKeehan, Jeffrey, Aboodi, Michael, Clements, Casey M., Busse, Laurence, Wira, Charles, Applegate, Darrin, Chen, Jen-Ting (Tina), Middleton, Elizabeth A., Mann, Rosen, Fowler, Alpha, Bledsoe, Joseph, Qadir, Nida, Narron, Kyle, Jones, Lisa, Gardner-Gray, Jayna, Marchetti, Nathaniel, Montgomery, Quinn, Black, Lauren, Thorton-Thompson, Sherell, Prekker, Matthew E., Hope, Aluko, Gentile, Nina, Wilson, Jo Ellen, Hilz, Katlyn, Guirgis, Faheem, McBryde, Breana, Miller, Stephen, Gajic, Ognjen, Finck, Lani, Khan, Akram, Higgins, Carrie, Krol, Olivia, Beutler, Rebecca, Siner, Jonathan, Vanme

2023

Overview

Sepsis is associated with long-term cognitive impairment and worse psychological and functional outcomes. Potential mechanisms include intracerebral oxidative stress and inflammation, yet little is known about the effects of early antioxidant and anti-inflammatory therapy on cognitive, psychological, and functional outcomes in sepsis survivors. To describe observed differences in long-term cognitive, psychological, and functional outcomes of vitamin C, thiamine, and hydrocortisone between the intervention and control groups in the Vitamin C, Thiamine, and Steroids in Sepsis (VICTAS) randomized clinical trial. This prespecified secondary analysis reports the 6-month outcomes of the multicenter, double-blind, placebo-controlled VICTAS randomized clinical trial, which was conducted between August 2018 and July 2019. Adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction who survived to discharge or day 30 were recruited from 43 intensive care units in the US. Participants were randomized 1:1 to either the intervention or control group. Cognitive, psychological, and functional outcomes at 6 months after randomization were assessed via telephone through January 2020. Data analyses were conducted between February 2021 and December 2022. The intervention group received intravenous vitamin C (1.5 g), thiamine hydrochloride (100 mg), and hydrocortisone sodium succinate (50 mg) every 6 hours for 96 hours or until death or intensive care unit discharge. The control group received matching placebo. Cognitive performance, risk of posttraumatic stress disorder and depression, and functional status were assessed using a battery of standardized instruments that were administered during a 1-hour telephone call 6 months after randomization. After exclusions, withdrawals, and deaths, the final sample included 213 participants (median [IQR] age, 57 [47-67] years; 112 males [52.6%]) who underwent long-term outcomes assessment and had been randomized to either the intervention group (n = 108) or control group (n = 105). The intervention group had lower immediate memory scores (adjusted OR [aOR], 0.49; 95% CI, 0.26-0.89), higher odds of posttraumatic stress disorder (aOR, 3.51; 95% CI, 1.18-10.40), and lower odds of receiving mental health care (aOR, 0.38; 95% CI, 0.16-0.89). No other statistically significant differences in cognitive, psychological, and functional outcomes were found between the 2 groups. In survivors of sepsis, treatment with vitamin C, thiamine, and hydrocortisone did not improve or had worse cognitive, psychological, and functional outcomes at 6 months compared with patients who received placebo. These findings challenge the hypothesis that antioxidant and anti-inflammatory therapy during critical illness mitigates the development of long-term cognitive, psychological, and functional impairment in sepsis survivors. ClinicalTrials.gov Identifier: NCT03509350.

• Publisher: American Medical Association
• Subject: Adult / Antioxidants / Ascorbic Acid - therapeutic use / Cognition / Critical Care Medicine / Humans / Hydrocortisone - therapeutic use / Male / Middle Aged / Online Only / Original Investigation / Sepsis - drug therapy / Steroids / Thiamine - therapeutic use / Vitamins