Early Vitamin C and Thiamine Administration to Patients with Septic Shock in Emergency Departments: Propensity Score-Based Analysis of a Before-and-After Cohort Study
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Design and Population
2.2. Data Collection
2.3. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | Overall (n = 1144) | Treatment Group (n = 229) | Control Group (n = 915) | p |
---|---|---|---|---|
Age (years) | 67 (58–75) | 67 (58–76) | 67 (60–75) | 0.91 |
Sex, male | 713 (62.3) | 136 (59.4) | 577 (63.1) | 0.30 |
Comorbidities | ||||
Hypertension | 412 (36.1) | 89 (38.9) | 323 (35.3) | 0.31 |
Diabetes | 335 (29.3) | 71 (31.0) | 264 (28.9) | 0.52 |
Cardiac disease | 152 (13.3) | 24 (10.5) | 128 (13.4) | 0.16 |
Chronic lung disease | 94 (8.2) | 17 (7.4) | 77 (8.4) | 0.62 |
Chronic renal disease | 78 (6.8) | 15 (6.6) | 63 (6.9) | 0.85 |
Chronic liver disease | 180 (15.7) | 35 (15.3) | 145 (15.9) | 0.83 |
Hematologic malignancy | 113 (9.9) | 19 (8.3) | 94 (10.3) | 0.37 |
Metastatic solid cancer | 364 (31.8) | 72 (31.4) | 292 (31.9) | 0.89 |
Suspected infection focus | 0.04 | |||
Respiratory infection | 268 (22.4) | 41 (17.9) | 227 (24.8) | |
Urinary tract infection | 158 (13.8) | 41 (17.9) | 117 (12.8) | |
Intra-abdominal infection | 435 (38.0) | 85 (37.1) | 350 (38.3) | |
Others or unknown | 283 (24.7) | 62 (27.1) | 221 (24.2) | |
Laboratory tests | ||||
White blood cell count, ×103/μL | 9.6 (4.5–16.3) | 8.1 (4.1–15.1) | 9.9 (4.6–16.9) | 0.17 |
Hemoglobin (g/dL) | 10.7 (9.0–12.4) | 10.6 (9.0–12.2) | 10.8 (9.0–12.5) | 0.33 |
Platelet count (×103/μL) | 137 (66–215) | 132 (72–183) | 138 (65–225) | 0.30 |
Creatinine (mg/dL) | 1.3 (0.9–2.0) | 1.4 (1.0–2.2) | 1.3 (0.9–2.0) | 0.06 |
ALT (U/L) | 28 (16–57) | 30 (16–57) | 28 (16–57) | 0.85 |
Albumin (g/dL) | 2.9 (2.4–3.4) | 2.8 (2.4–3.3) | 3.0 (2.5–3.4) | 0.01 |
Initial lactate (mmol/L) | 3.6 (2.0–5.5) | 3.4 (2.1–5.7) | 3.7 (1.9–5.5) | 0.72 |
Blood culture—positive | 484 (42.3) | 367 (40.1) | 117 (51.1) | <0.01 |
Septic shock criteria, Sepsis-3 consensus definition | 593 (51.8) | 152 (66.4) | 441 (48.2) | <0.01 |
Adjunctive steroid use within 48 h | 287 (25.1) | 62 (27.1) | 225 (24.6) | 0.43 |
Vasopressor use | 966 (84.4) | 217 (94.8) | 749 (81.9) | <0.01 |
Mechanical ventilation | 328 (17.9) | 67 (39.3) | 261 (28.5) | 0.82 |
Interventions for source control | 332 (29.0) | 58 (25.3) | 274 (30.0) | 0.16 |
Maximum SOFA score in 24 h | 8 (5–11) | 9 (6–12) | 8 (5–11) | <0.01 |
APACHE II score | 20 (15–27) | 27 (21–52) | 27 (20–56) | 0.99 |
Overall Cohort | Propensity-Matched Cohort | |||||
---|---|---|---|---|---|---|
Treatment (n = 229) | Control (n = 915) | p | Treatment (n = 227) | Control (n = 527) | p | |
28-day mortality | 42 (18.3) | 160 (17.5) | 0.76 | 42 (18.5) | 92 (17.5) | 0.84 |
In-hospital mortality | 38 (16.6) | 167 (18.3) | 0.55 | 38 (16.7) | 97 (18.4) | 0.54 |
ICU LOS (days) | 4 (3–8) | 4 (3–8) | 0.70 | 4 (3–8) | 4 (3–7) | 0.84 |
Hospital LOS (days) | 14 (9–22) | 13 (8–23) | 0.49 | 14 (9–22) | 13 (8–23) | 0.33 |
Duration of mechanical ventilation | 6.0 (3.0–15.0) | 6.0 (3.0–12.0) | 0.61 | 5.5 (3.0–15.0) | 5.0 (3.0–10.0) | 0.63 |
New use of renal replacement therapy | 28 (12.3) | 106 (11.9) | 0.87 | 28 (12.4) | 66 (12.9) | 0.51 |
Variable | 28-Day Mortality | In-Hospital Mortality | ||||
---|---|---|---|---|---|---|
Adjusted OR | 95% CI | p | Adjusted OR | 95% CI | p | |
Vitamin treatment | 0.86 | 0.56–1.33 | 0.51 | 0.69 | 0.44–1.08 | 0.11 |
Infection focus | ||||||
Respiratory | Reference | Reference | ||||
UTI | 0.52 | 0.26–1.04 | 0.06 | 0.36 | 0.18–0.74 | 0.01 |
Abdomen | 0.73 | 0.45–1.20 | 0.22 | 0.52 | 0.32–0.86 | 0.01 |
Other | 1.08 | 0.67–1.74 | 0.75 | 0.77 | 0.47–1.25 | 0.29 |
WBC count (>12,000/μL) | 1.25 | 0.87–1.79 | 0.22 | 1.33 | 0.93–1.92 | 0.12 |
Creatinine (>2.0 mg/dL) | 0.93 | 0.62–1.40 | 0.73 | 0.84 | 0.55–1.29 | 0.43 |
Albumin (<3.0 mg/dL) | 3.00 | 2.05–4.39 | <0.01 | 3.29 | 2.13–5.06 | <0.01 |
Blood culture positive | 0.51 | 0.34–0.76 | <0.01 | 0.67 | 0.45–1.01 | 0.06 |
Septic shock criteria | 2.16 | 1.36–3.43 | <0.01 | 2.88 | 1.75–4.72 | <0.01 |
Vasopressor use | 0.25 | 0.14–0.47 | <0.01 | 0.22 | 0.11–0.42 | <0.01 |
Source control interventions | 0.58 | 0.36–0.93 | 0.02 | 0.55 | 0.34–0.88 | 0.01 |
Maximum 24-h SOFA score | 1.30 | 1.23–1.37 | <0.01 | 1.31 | 1.23–1.38 | <0.01 |
Subgroups | 28-Day Mortality | In-Hospital Mortality | ||
---|---|---|---|---|
Treatment | Control | Treatment | Control | |
Age (years) | ||||
>75 | 20.7 (12/58) | 17.5 (42/240) | 20.0 (11/58) | 17.9 (43/240) |
≤75 | 17.5 (30/171) | 17.5 (118/675) | 15.8 (27/171) | 18.4 (124/675) |
Renal failure | ||||
Yes | 29.7 (19/64) | 25.8 (59/229) | 25.0 (16/64) | 26.2 (60/229) |
No | 13.9 (23/165) | 14.7 (101/686) | 13.3 (22/165) | 15.6 (107/686) |
Malignancy | ||||
Yes | 24.1 (22/91) | 23.7 (91/384) | 22.0 (20/91) | 24.0 (92/384) |
No | 14.5 (20/138) | 13.0 (69/531) | 13.0 (13/138) | 14.1 (75/531) |
Albumin (mg/dL) | ||||
≥3.0 | 13.6 (12/88) | 9.0 (42/465) | 12.5 (11/88) | 9.9 (46/465) |
<3.0 | 21.3 (30/141) | 26.2 (118/450) | 19.2 (27/141) | 26.9 (121/450) |
Septic shock criteria | ||||
Yes | 23.0 (35/152) | 24.7 (109/441) | 21.7 (33/152) | 27.2 (120/441) |
No | 9.1 (7/77) | 10.8 (51/474) | 6.5 (5/77) | 9.9 (47/474) |
SOFA score | ||||
>10 | 30.1 (22/73) | 38.7 (89/230) | 28.8 (21/73) | 42.2 (97/230) |
≤10 | 12.8 (20/156) | 10.4 (71/685) | 10.9 (17/156) | 10.2 (70/685) |
Adjunctive steroid use | ||||
Yes | 32.3 (20/62) | 30.7 (69/225) | 29.0 (18/62) | 33.3 (75/225) |
No | 13.2 (22/167) | 13.2 (91/690) | 12.0 (20/167) | 13.3 (92/690) |
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Shin, T.G.; Kim, Y.-J.; Ryoo, S.M.; Hwang, S.Y.; Jo, I.J.; Chung, S.P.; Choi, S.-H.; Suh, G.J.; Kim, W.Y. Early Vitamin C and Thiamine Administration to Patients with Septic Shock in Emergency Departments: Propensity Score-Based Analysis of a Before-and-After Cohort Study. J. Clin. Med. 2019, 8, 102. https://doi.org/10.3390/jcm8010102
Shin TG, Kim Y-J, Ryoo SM, Hwang SY, Jo IJ, Chung SP, Choi S-H, Suh GJ, Kim WY. Early Vitamin C and Thiamine Administration to Patients with Septic Shock in Emergency Departments: Propensity Score-Based Analysis of a Before-and-After Cohort Study. Journal of Clinical Medicine. 2019; 8(1):102. https://doi.org/10.3390/jcm8010102
Chicago/Turabian StyleShin, Tae Gun, Youn-Jung Kim, Seung Mok Ryoo, Sung Yeon Hwang, Ik Joon Jo, Sung Phil Chung, Sung-Hyuk Choi, Gil Joon Suh, and Won Young Kim. 2019. "Early Vitamin C and Thiamine Administration to Patients with Septic Shock in Emergency Departments: Propensity Score-Based Analysis of a Before-and-After Cohort Study" Journal of Clinical Medicine 8, no. 1: 102. https://doi.org/10.3390/jcm8010102