Thiamine Improves Lactate Clearance in Septic Shock

The administration of thiamine within 24 hours of hospital admission to patients with septic shock was associated with improved lactate clearance and a reduction in mortality rate, according to the results of a study published in Critical Care Medicine.

Septic shock has a very similar presentation to thiamine deficiency, and many critically ill patients have thiamine deficiency. Metabolic stress, poor nutrition, and comorbidities may play important roles in the development of thiamine deficiency. A recent study found conflicting evidence as to the benefit of thiamine in septic shock, with no benefit found for the study group as a whole. However, in a subgroup of patients with septic shock and laboratory-confirmed thiamine deficiency, thiamine administration resulted in reduced lactate levels at 24 hours and reduced mortality.

Jordan A. Woolum, PharmD, of the Department of Pharmacy Services at the University of Kentucky HealthCare in Lexington and colleagues conducted a retrospective, single-center, matched cohort study in adults admitted with a diagnostic code of septic shock to either the medical or surgical intensive care unit of a tertiary care academic medical center.

Patients who received intravenous thiamine supplementation within 24 hours of hospital admission were compared with a control cohort of patients who did not receive the intervention. The primary study outcome was reduced time to lactate clearance in septic shock; 28-day mortality was a secondary outcome. Other outcomes included acute kidney injury and the need for renal replacement therapy as well as vasopressor and mechanical ventilation-free days.

Investigators analyzed data from 123 patients treated with thiamine and 246 patients who did not receive thiamine. Thiamine treatment improved the likelihood of lactate clearance (subdistribution hazard ratio, 1.307; 95% CI, 1.002-1.704) and was associated with a reduction in 28-day mortality (hazard ratio, 0.666; 95% CI, 0.490-0.905). No differences for thiamine administration were observed in any other outcomes.

Important study limitations include that the prescription of thiamine was not randomized, but given when the clinician suspected a thiamine deficiency. In addition, no standardized protocol existed for the administration of thiamine, and the data are limited to those in the electronic health records because of the retrospective nature of the study.

The authors called for further randomized trials to evaluate thiamine as treatment for septic shock.

Reference

Woolum JA, Abner EL, Kelly A, Thompson Bastin ML, Morris PE, Flannery AH. Effect of thiamine administration on lactate clearance and mortality in patients with septic shock [published online July 18, 2018]. Crit Care Med. doi:10.1097/CCM.0000000000003311