Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial

SPS commentary:

A related commentary highlights that the use of vitamin C for treatment of patients with sepsis has generated substantial interest and controversy following an observational study in 2017, which suggested that the combination of high-dose vitamin C, thiamine, and hydrocortisone in conjunction with usual care was associated with reduced mortality.

 

The results of this new clinical trial, added to the cumulative evidence from 13 different studies performed in 10 different countries, now indicate that high dose vitamin C with or without thiamine and steroids does not provide significant survival benefits for patients with sepsis or septic shock. Given that other studies are also being planned, there appears to be no immediate justification for adoption of high dose vitamin C, alone or in combination, as a component of treatment for sepsis. Moreover, use of high-dose vitamin C in combination or alone “just in case” or as a “measure of last resort,” aside from providing no survival benefits, could have several other potential consequences, including diverting funding from needed research to examine sepsis mechanisms and diagnostics; stifling the development of other sepsis therapies; perpetuating false hopes for patients, families, and clinicians; and delaying proven lifesaving therapies such as prompt initiation of antibiotic therapy.