IV Vitamin C in Sepsis with Thiamine and Hydrocortisone

This article is hot-off-the-press regarding vitamin C, thiamine and hydrocortisone in refractory septic shock. This regimen is known as HAT therapy in some corners of the world. It was actually published today, 5/5/20. It is NOT a randomized control trial but at least they went through the trouble of conducting a propensity matched, before-after, case control study. This is actually the type of study I would like to publish with the data we’ve collected at my shop. There are a ton of limitations that come with this type of study by default. For the litany of questions on how this all works, please check the background portion of the paper. In the discussion, the authors also take apart many studies preceding theirs. I have taken apart many things regarding IV Vitamin C in a long blog post here.

n=56 who received HAT therapy, n=56 who got only hydrocortisone.

Regimen of vitamin c, thiamine and hydrocortisone

Hydrocortisone: 240mg/day. Note that this is via a continuous drip.
Vitamin C: 1.5gm IV q6h
Thiamine 200mg IV q12h
Mean duration of therapy: 3 days
Other: 75% of patients in each group received IgM

Results of vitamin c, thiamine and hydrocortisone:

Decreased length of mechanical ventilation (p=0.01) shaving it down from 6 days to 3 days. There was also a trend towards lower 30 day and hospital mortality (p=0.11: not statistically significant).

Disappointing takeaway point:

An important disappointing takeaway point, for me at least, is the 30-day mortality was still 42.8% in this small study even with HAT therapy. They were taking care of some sick sick patients but the PROMISE, PROCESS, and ARISE trials all had mortality rates under 30%. This is obviously not a magical cure.

I have to tip my hat to these authors because, from their experience, I will have a great idea of how to structure my own paper on the matter. Make sure to download the free article for yourself. This is not medical advice.


C. Irene, B. Emanuela, V. Sophie, et al., Adjunctive therapy with vitamin c and thiamine in patients treated with steroids for refractory septic shock: A propensity matched before-after, case-control study, Journal of Critical Care (2020), https://doi.org/10.1016/j.jcrc.2020.04.014
Link to Article

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