Use of Hydrocortisone, Ascorbic Acid, and Thiamine in Adults with Septic Shock
Rationale and Objectives This study aims to describe administration of hydrocortisone, high-dose ascorbic acid, and thiamine (HAT therapy) among US adults with septic shock before and after publication of a single-center study and to compare outcomes between patients who received, and did not receive, HAT therapy. Methods Retrospective cohort study of 379 acute care hospitals in the Premier Healthcare Database including patients discharged October 1, 2015-June 30, 2018. Exposure was quarter year of hospital discharge; post-publication was defined as January 2017 onward (July 2017 for effectiveness analyses). The primary outcome was receipt of HAT at least once during hospitalization. We conducted unadjusted segmented regression analyses to examine temporal trends in HAT administration. In patients with early septic shock, we compared the association of early HAT therapy (within two days of hospitalization) with hospital mortality using multivariable modeling and propensity score matching. Measurements and Main Results Among 338,597 patients, 3,574 (1.1%) received HAT therapy; 98.7% in the post-publication period. HAT administration increased from 0.03% of patients (95% CI 0.02-0.04) pre-publication to 2.65% (95% CI 2.46-2.83) in the last quarter, with a significant step-up in use after December 2016 (P<0.001). Receipt of early HAT was associated with higher hospital mortality (28.2% vs. 19.7%; P<0.001; adjusted odds ratio (aOR) 1.17 (95% CI 1.02-1.33); primary propensity-matched model aOR 1.19 (95% CI 1.02-1.40)). Conclusions Publication of a single-center retrospective study was associated with significantly increased administration of HAT. Among patients with early septic shock, receipt of HAT was not associated with mortality benefit.
Keywords: ascorbic acid; critical care; physicians' practice patterns; septic shock.
Vail EA, Wunsch H, Pinto R, Bosch NA, Walkey AJ, Lindenauer PK, Gershengorn HB. Use of Hydrocortisone, Ascorbic Acid, and Thiamine in Adults with Septic Shock. Am J Respir Crit Care Med. 2020 Jul 24. doi: 10.1164/rccm.202005-1829OC. Epub ahead of print.