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The following is a summary of “Differential effects of thiamine and ascorbic acid in clusters of septic patients identified by latent variable analysis,” published in the November 2024 issue of Critical Care by Legouis et al. 

Thiamine and ascorbic acid have been suggested as potential therapies to reduce the impact of sepsis and septic shock. However, randomized controlled trials (RCTs) have not shown clear benefits, and variations in treatment response were suspected.  

Researchers conducted a retrospective study to evaluate the heterogeneity of the treatment effect of thiamine (B1) and the combination of thiamine with ascorbic acid (AA+ B1) in individuals with sepsis in critical care.  

They included all adult patients admitted to the intensive care unit (ICU) with sepsis or septic shock between January 2012 and August 2022. Patient clusters were identified using latent variable analysis based on demographic and physiological data obtained within 24 hours of admission. In-hospital mortality was compared within each cluster using inverse probability-weighted Cox models across 3 groups: those receiving standard treatment (control), standard treatment with thiamine (B1 group), and standard treatment with thiamine and ascorbic acid (AA + B1 group).  

The results showed that 3,465 individuals with sepsis were included, with 2,183 in the standard treatment group, 1,054 in the thiamine (B1) group, and 228 in the thiamine and ascorbic acid (AA + B1) group, 5 patient clusters were identified: “Cluster Severe” (most critically ill), “Cluster Resp” (predominantly respiratory failure), “Cluster Old” (elderly with multiple comorbidities), “Cluster Fit” (young and healthy), and “Cluster Liver” (liver failure), B1 treatment reduced in-hospital mortality was associated in “Cluster Severe” and “Cluster Resp,” while the AA + B1 combination showed no mortality reduction and increased mortality in “Cluster Old.”  

Investigators concluded the combination of AA and B1 showed no benefit and potential harm in older patients with comorbidities, B1 supplementation alone may improve ICU survival in the most severe patients with predominant respiratory failure. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05188-4