• Tomoko Fujii, Adam M Deane, and Priya Nair.
• ANZIC-RC, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
• Curr Opin Crit Care. 2020 Aug 1; 26 (4): 363-368.

Purpose Of ReviewSepsis is a global health issue, and there is a need for effective, low-cost adjunct metabolic treatments. Corticosteroids have been investigated in many trials for decades, and recently the administration of vitamin C, thiamine (vitamin B1), and vitamin D have been proposed as novel therapies in patients with sepsis.Recent FindingsAPROCCHSS (N = 1241) and ADRENAL (N = 3800) trial reported inconsistent results in mortality outcome; however, both demonstrated a decreased duration of shock with low-dose corticosteroids. The CITRIS-ALI trial (N = 170) examined the effects of intravenous vitamin C 200 mg/kg/day and reported no effect on organ dysfunction or biomarkers. The VITAMINS trial (N = 216) compared combination therapy of vitamin C 6 g/day, thiamine 200 mg/day, and hydrocortisone 200 mg/day with hydrocortisone alone to find that the combination did not increase vasopressor free time. A single trial (N = 88) evaluating the effect of thiamine in patients with sepsis reported a neutral result. Two randomized trials (N = 475 and N = 1360) on the supplementation of vitamin D in the critically ill patients did not identify statistically significant reduction in mortality.SummaryEvidence from high-quality research is still insufficient to support the use of vitamin C, thiamine, and vitamin D as metabolic support in sepsis treatment.

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