R.E.B.E.L.EM - May 18, 2020 - By Salim Rezaie
"Paper: Chang P et al. Combined Treatment with Hydrocortisone, Vitamin C, and Thiamine for Sepsis and Septic Shock (HYVCTTSSS): A Randomized Controlled Clinical Trial. CHEST 2020. PMID: 32243943
Clinical Question: Does the “metabolic cocktail” improve 28 day mortality in patients with sepsis and septic shock in comparison to placebo?
Author Conclusion: “Among patients with sepsis or septic shock, the combination of hydrocortisone, vitamin C, and thiamine did not reduce mortality compared with placebo.”
Clinical Take Home Point: This single center, small study doesn’t really add much to our knowledge of the metabolic cocktail in sepsis. The 28-mortality difference goal of 30% was too large and most likely confirms the methodologically flawed before and after Marik study results were overstated."