氢化可的松、抗坏血酸和硫胺素联合应用对脓毒症和脓毒性休克患者的影响：一项系统评价和荟萃分析

Effect of Combined Hydrocortisone, Ascorbic Acid and Thiamine for Patients with Sepsis and Septic Shock: A Systematic Review and Meta-Analysis.

作者信息

Wu Tong, Hu Chang, Huang Weipeng, Xu Qiancheng, Hu Bo, Li Jianguo

机构信息

Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.

Clinical Research Center of Hubei Critical Care Medicine, Wuhan, Hubei, China.

出版信息

Shock. 2021 Dec 1;56(6):880-889. doi: 10.1097/SHK.0000000000001781.

DOI:10.1097/SHK.0000000000001781

PMID:34529397

Abstract

OBJECTIVE

This study aims to assess the effect of HAT therapy on patients with sepsis and septic shock.

METHODS

We searched PubMed, Embase, and Cochrane Library for studies on HAT therapy published up to November 11, 2020. The primary outcome was the duration of vasopressor use. Secondary outcomes were change of Sequential Organ Failure Assessment (SOFA) score within 72 h; death within intensive care unit (ICU), hospital, and 28 or 30 days; length of stay in ICU and hospital; rate of procalcitonin (PCT) clearance and incidence of adverse events. We also used trial sequential analysis (TSA) to assess the reliability of the available evidence.

RESULTS

Six randomized controlled trials (RCTs) and seven observational studies enrolling 1,559 patients were included (762 were treated with HAT, and 797 were treated with hydrocortisone alone, standard care or placebo). HAT therapy was associated with significant reductions in duration of vasopressor use (mean differences [MD], -14.68, [95% CI, -24.28 to -5.08], P = 0.003) in RCTs, but not in observational studies (MD, 11.21 [95% CI, -44.93 to 67.35], P = 0.70). HAT therapy was associated with less organ dysfunction at 72 h both in RCTs (MD, -0.86 [95% CI, -1.32 to -0.40], P < 0.001) and observational studies (MD, -2.65 [95% CI, -5.29 to -0.01], P = 0.05). HAT therapy was associated with lower hospital mortality and higher PCT clearance in observational studies. Similar results for the primary outcome were found in the sensitivity analysis. TSA results suggested more trials to reach the required information size.

CONCLUSION

Among patients with sepsis and septic shock, a combination therapy of hydrocortisone, ascorbic acid, and thiamine, compared with placebo, could reduce the duration of vasopressor use and SOFA scores during the first 72 h.

TRIAL REGISTRATION

PROSPERO registration ID for this study is CRD42020170648 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170648).

摘要

目的

本研究旨在评估氢化可的松、维生素C和维生素B1联合治疗（HAT疗法）对脓毒症和脓毒性休克患者的疗效。

方法

我们检索了PubMed、Embase和Cochrane图书馆，查找截至2020年11月11日发表的关于HAT疗法的研究。主要结局指标是血管活性药物使用时间。次要结局指标包括72小时内序贯器官衰竭评估（SOFA）评分的变化；重症监护病房（ICU）、医院内以及28或30天内的死亡情况；在ICU和医院的住院时间；降钙素原（PCT）清除率以及不良事件的发生率。我们还采用了试验序贯分析（TSA）来评估现有证据的可靠性。

结果

纳入了6项随机对照试验（RCT）和7项观察性研究，共1559例患者（762例接受HAT治疗，797例接受单独氢化可的松治疗、标准治疗或安慰剂治疗）。在随机对照试验中，HAT疗法与血管活性药物使用时间显著缩短相关（平均差[MD]，-14.68，[95%置信区间，-24.28至-5.08]，P = 0.003），但在观察性研究中并非如此（MD，11.21 [95%置信区间，-44.93至67.35]，P = 0.70）。在随机对照试验（MD，-0.86 [95%置信区间，-1.32至-0.40]，P < 0.001）和观察性研究（MD，-2.65 [95%置信区间，-5.29至-0.01]，P = 0.05）中，HAT疗法均与72小时时器官功能障碍减轻相关。在观察性研究中，HAT疗法与较低的医院死亡率和较高的PCT清除率相关。敏感性分析中主要结局指标得到了类似结果。TSA结果表明需要更多试验以达到所需的信息量。