Hydrocortisone Combined with Vitamin C and Thiamine in the Treatment of Sepsis/Septic Shock: A Systematic Review with Meta-Analysis and Trial Sequential Analysis

source extracted confidence: high 2026-04-09
#humans #hydrocortisone #shock-septic #ascorbic-acid #thiamine

Hydrocortisone Combined with Vitamin C and Thiamine in the Treatment of Sepsis/Septic Shock: A Systematic Review with Meta-Analysis and Trial Sequential Analysis

Lu et al., 2023 | Clin Invest Med | Meta Analysis

Citation

Lu Difan, Mao Wenchao. Hydrocortisone Combined with Vitamin C and Thiamine in the Treatment of Sepsis/Septic Shock: A Systematic Review with Meta-Analysis and Trial Sequential Analysis. Clin Invest Med. 2023-Mar-26;46(1):E36-49. doi:10.25011/cim.v46i1.40275

Abstract

BACKGROUND: This study explored the efficacy of hydrocortisone combined with vitamin C and thiamine (HVT) in the treatment of sepsis/septic shock. METHODS: PubMed, EMBASE and Web of Science were searched (establishment of the database to October 31, 2022). The meta-analysis included randomized controlled trials (RCTs); comparing the efficacy of HVT regimen and placebo in the treatment of sepsis/septic shock. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias. The Review Manager 5.4 software was used for meta-analysis, and the relative risk (RR), mean difference (MD) and 95% confidence intervals (CI) were then determined. Trial sequential analysis (TSA) was then conducted. RESULTS: Eight RCTs with 1,572 patients were identified. Meta-analysis showed that HVT regimen did not reduce all-cause (RR=0.96, 95% CI: 0.83 - 1.11, P=0.60), hospital (RR=1.03, 95% CI: 0.83 - 1.27, P=0.80) or intensive care unit (ICU) mortalities (RR=1.05, 95% CI: 0.86 - 1.28, P=0.65). Furthermore, there was no significant difference in the change of sequential organ failure assessment score, length of ICU stay, length of hospital stay, duration of the use of vasopressors, incidence of acute kidney injury and ventilator-free days between HVT and control groups. TSA showed that more trials are needed to confirm the results. CONCLUSIONS: HVT regimen did not reduce the mortality of patients with sepsis/septic shock and was not associated with a significant improvement in outcomes. The TSA result showed that more RCTs with high quality and large sample sizes are needed to further confirm the results.

Key Findings

Eight RCTs with 1,572 patients were identified. Meta-analysis showed that HVT regimen did not reduce all-cause (RR=0.96, 95% CI: 0.83 - 1.11, P=0.60), hospital (RR=1.03, 95% CI: 0.83 - 1.27, P=0.80) or intensive care unit (ICU) mortalities (RR=1.05, 95% CI: 0.86 - 1.28, P=0.65). Furthermore, there was no significant difference in the change of sequential organ failure assessment score, length of ICU stay, length of hospital stay, duration of the use of vasopressors, incidence of acute kidney inj

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population sepsis
Sample Size 1572
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Hydrocortisone
  • Shock, Septic
  • Ascorbic Acid
  • Thiamine
  • Intensive Care Units
  • Sepsis

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Meta-Analysis, Systematic Review, Journal Article, Research Support, Non-U.S. Gov't
  • Vertical: vitamin-c

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09